A New Horizon in Research

MARK MEISSNER, MD CHAIR, RESEARCH STANDING COMMITTEE

When we consider the three tenets of the American Vein & Lymphatic Society, we must realize that advancements in the science of venous and lymphatic disease through Research is critical if we are to achieve our other tenets of Advocacy and Education. The AVLS began the pursuit of advancing research several years ago with a multi-million dollar investment in the development and deployment of the PRO Venous Registry recognizing that it is only with “big data” that we will be able to provide the clinical and scientific evidence required to support the future of the field and improve the quality of care for our patients.

Now we are embarking on the next phase of our research investments and initiatives, which are overseen by three different Advisory Committees of the AVLS.

First, we have the PRO Registry Operations Committee that is chaired by Joe Jenkins, MD, FACS, FAVLS, RPVI, RPhS, RVT, CWSP. This committee is responsible for the over-site and management of the PRO Venous Registry to ensure the system is operational and the data integrity is protected and to facilitate the expansion of the data collected along with the addition of new providers.

In 2018, the AVLS agreed to invest in upgrading the PRO Venous Registry platform from our original 1.0 version to a more modern and user friendly 2.0 version. The Operations Committee has been hard at work at getting this new database functional. This has required an essential rebuild of the entire database. The beta testing of uploaded data was completed in May 2019. Three of our major provider groups, the Center for Vein Restoration, Vein Clinics of America and Streamline MD have been working hard to get their data into the new registry, with a commitment of completion by the end of October. Testing of the query component of the registry has been completed. The PRO 2.0 registry now provides an easy way to compare pretreatment and post treatment patient reported outcome data within the registry. The minimum data set requirements for superficial vein treatments that a practice needs to provide to the registry have been finalized. Registry participants will need to agree to provide, as a minimum, this data. The minimum data set for pelvic vein and deep vein treatments is in the development phase. As data analysis is initiated, AVLS will begin the process of developing specific vein therapy quality measures. This will allow submission of pertinent information to CMS in regard to MIPS and MACRA requirements. The Operations Committee knows that upgrades to PRO 2.0 will be an ongoing process and a major undertaking for 2020 will be the development of a Lymphedema Module in the registry.

Second, the AVLS has undertaken the development of three new clinical practice guidelines under the leadership of Mark Meissner, MD. In the summer of 2018, the Guidelines Advisory Committee met at the AVLS headquarters in Chicago where Dr. Gordon Guyett came to train our members on the ins and outs of developing and writing quality clinical guidelines. Coming out of that training opportunity the committee agreed to pursue the development of the following guidelines: C2 disease – Varicose Veins in cooperation with the AVF and SIR, Pelvic Vein Reflux, and Chronic Venous Obstructions. These projects are underway and are expected to be ready for publication in mid to late 2020. The AVLS will be working with the Alliance for the Implementation of Clinical Guidelines a relatively new Guideline Clearing house replacing the AHRQ National Guideline Clearing house that closed in 2018.

And most recently, the FVLD is providing a grant to the AVLS made possible by Tactile Medical to begin the development of a clearing house quality clinical guideline in Lymphedema. This project team is currently being recruited and will begin work in early 2020.

The development of clinical guidelines is a critical responsibility of medical societies, and the AVLS as the leading society in venous and lymphatic disease is committed to these and future projects that will support our desire to affect payment and treatment policy for our patients across the US.

Our third and arguably greatest opportunity to impact the field of venous and lymphatic medicine is the investment in pursuing new research. The Research & Scientific Committee is chaired by Kathleen Gibson, MD.

With the advancements in the PRO 2.0 Venous Registry, we now have sufficient data to begin conducting research across a wide magnitude of topics and areas where we will be able to truly understand the outcomes of treatments for venous and lymphatic disease on our patients. Our goal is to produce a minimum of six to eight new and unique research projects a year. As the research is developed, our goal as a Society is to be able to provide the data that helps us impact payor policy and clinical practice.

If you never thought of the AVLS as a researchbased Society, it is time to reconsider your opinion. Not only are we investing to pursue new research out of the PRO 2.0 Venous Registry, but also, we have been selected through the Foundation to conduct two new commissioned research projects. Grants made possible by Medtronic and Merit Medical have been approved and utilize the PRO 2.0 Venous Registry to understand the long-term outcomes of their new innovative technologies for vein ablation. These projects are multi-year studies and will commence early in 2020.

As you can see there is a tremendous opportunity at AVLS to get involved in supporting our Research initiatives, and we ask you to consider getting involved and volunteering for a committee or at a minimum consider becoming a provider of data to the PRO 2.0 Venous Registry. Take a look around for one of our Committee Volunteers for Research and make sure to find out how you can become involved.