The Massachusetts General Hospital Vascular Center: emergence of a multidisciplinary program designed to improve quality outcomes for patients.

The prevalence of cardiovascular disease in the United States is extensive and growing rapidly. Contributing factors include the aging population, tobacco abuse, obesity, and diabetes, all of which increase the prevalence of cardiovascular diseases. Treatment paradigms for cardiovascular disease have also been rapidly evolving; minimally invasive, catheter-based approaches are increasingly used as first-line therapy. Physicians from a variety of specialties have responded to this growing patient population and treatment paradigm shift by enhancing their training and expanding their practices to better care for these complex patients. This trend is a natural response of specialists to the evolving needs of their patients. In the vascular field, however, it has led to physicians acquiring skill sets that are new for that specialty and that go beyond the traditional boundaries of their practice, and which may overlap with skills classically practiced by other specialists. Surgeons are learning endovascular techniques previously performed by interventional radiologists; cardiologists are utilizing their knowledge about atherosclerosis and their catheter skills to manage noncardiac disease; neurologists and neurosurgeons are developing catheter-based techniques; and nephrologists are performing dialysis-access intervention. As a result, there is now much more overlap in the capabilities of-and services offered by-each specialty. Unhealthy and counterproductive competition among traditional disciplines has developed in the field of vascular care. This article describes the development of a multispecialty collaborative vascular center at a large urban academic medical center to demonstrate a new practice paradigm designed to improve quality of care for patients and enhance collaborative professional education and research.