Eleven performance measures for elective percutaneous coronary interventions (PCI) directly address appropriateness of the procedure in ambulatory and inpatient settings, according to a collaborative effort among five medical societies.
The measures examine care before, during and after the procedure and incorporate other indicators of quality, such as procedural volume and whether the institution benchmarks care by participating in regional or national registries.
The 11 measures are:
1. comprehensive documentation of the reasons for PCI
2. an appropriate reason for elective PCI (benefits outweigh the risks)
3. an evaluation of the individual’s ability to receive dual antiplatelet therapy (conducted before the procedure)
4. the use of embolic protection devices in the treatment of saphenous vein bypass graft disease
5. an assessment of renal function before the procedure (including glomerular filtration rate) and the documentation of contrast used during the procedure
6. documentation of the radiation dose used during the procedure
7. the prescription of optimal medical therapy at discharge (aspirin, PY12 inhibitors and statins)
8. a referral to an outpatient cardiac rehabilitation program (to reduce the risk of recurrent events)
9. participation in a regional or national PCI registry
10. the average annual volume of PCIs performed by the physician over the last 2 calendars years
11. the average annual volume of PCIs performed by the hospital over the last calendar year
The 2013 Performance Measures for Adults Undergoing Percutaneous Coronary Intervention appeared online in the Journal of the American College of Cardiology American College of Cardiology and at the American Heart Association’s website.
According to the writing committee, the measures may “serve as vehicles to accelerate appropriate translation of scientific evidence into clinical practice.” The committee goal was to create measures that capture many important aspects of quality while minimizing the reporting burden.
The committee identified 4 areas of research that will generate better performance measures in the future:
1. measuring the filling of prescriptions (not just the prescription of drugs) and optimal dosing,
2. better use of current data systems to track PCI quality,
3. building accountability by all practitioners involved into quality metrics, and
4. using patient surveys to track performance.
The performance measures released today by the American College of Cardiology, the American Heart Association, the Society for Cardiovascular Angiography and Interventions, the AMA-Convened Physician Consortium for Performance Improvement, and the National Committee for Quality Assurance.