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Klein LW, Dehmer GJ, Anderson HV, Rao SV. Overcoming Obstacles in Designing and Sustaining a High-Quality Cardiovascular Procedure Environment. JACC Cardiovasc Interv 2020; 13:2806-2810. [PMID: 33069644 DOI: 10.1016/j.jcin.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/07/2020] [Accepted: 06/02/2020] [Indexed: 11/30/2022]
Abstract
Accurate evaluation of the quality of invasive cardiology procedures requires appraisal of case selection, technical performance, and procedural and clinical outcomes. Regrettably, the medical care delivery system poses a number of obstacles to developing and sustaining a high-quality environment. The purposes of this viewpoint are to summarize the most common impediments, followed to summarize the most common impediments, followed by the optimal ways to design and sustain a quality assurance program to overcome these barriers. A 7-step program to create and implement an effective quality assurance program is outlined.
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Affiliation(s)
- Lloyd W Klein
- University of California-San Francisco, San Francisco, California, USA.
| | - Gregory J Dehmer
- Carilion Clinic Cardiology and the Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | | | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, North Carolina, USA
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Inohara T, Kohsaka S, Spertus JA, Masoudi FA, Rumsfeld JS, Kennedy KF, Wang TY, Yamaji K, Amano T, Nakamura M. Comparative Trends in Percutaneous Coronary Intervention in Japan and the United States, 2013 to 2017. J Am Coll Cardiol 2020; 76:1328-1340. [DOI: 10.1016/j.jacc.2020.07.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
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Abugroun A, Hassan A, Gaznabi S, Ayinde H, Subahi A, Samee M, Shroff A, Klein LW. Modified CHA 2DS 2-VASc score predicts in-hospital mortality and procedural complications in acute coronary syndrome treated with percutaneous coronary intervention. IJC HEART & VASCULATURE 2020; 28:100532. [PMID: 32455161 PMCID: PMC7235953 DOI: 10.1016/j.ijcha.2020.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/20/2020] [Accepted: 05/03/2020] [Indexed: 11/16/2022]
Abstract
Background Current risk prediction models in acute coronary syndrome (ACS) patients undergoing PCI are mathematically complex. This study was undertaken to assess the accuracy of a modified CHA2DS2-VASc score, comprised of easily accessible clinical factors in predicting adverse events. Methods The National Inpatient Sample (NIS) was queried for ACS patients who underwent PCI between 2010 and 2014. We developed a modified CHA2DS2-VASc score for risk prediction in ACS patients. Multivariate mixed effect logistic regression was utilized to study the adjusted risk for adverse outcomes based on the score. The primary outcome evaluated was in-hospital mortality. Secondary outcomes assessed were stroke, respiratory failure, acute kidney injury, all-cause bleeding, pacemaker insertion, vascular complications, length of stay and cost. Results There were 252,443 patients admitted with ACS included. Mean age was 62 ± 12 years. The mean CH3A2DS-VASc score was 1.6 ± 1.6. The in-hospital mortality rate was 2.5%. CH3A2DS-VASc score was highly correlated with increased rate of mortality and all secondary outcomes. ROC curve analysis for association of CH3A2DS-VASc score with mortality demonstrates that area under the curve (AUC) = 0.83 (95%C: 0.82–0.84). Stepwise increases in CH3A2DS-VASc score correlated with incremental risk, and total score was an independent predictor of mortality (adjusted OR: 1.99 (95%CI: 1.96–2.03) p < 0.001) and all secondary outcomes. Conclusion This study supports the applicability of the CH3A2DS-VASc score as an accurate risk prediction model for ACS patients undergoing PCI and could supplant more complicated models for quality assurance.
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Affiliation(s)
- Ashraf Abugroun
- Wayne State University/Detroit Medical Center, Detroit, MI, United States
| | - Abdalla Hassan
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Safwan Gaznabi
- University Hospitals Cleveland Medical Center, Case Western Reserve University, United States
| | | | - Ahmed Subahi
- Wayne State University/Detroit Medical Center, Detroit, MI, United States
| | - Mohammed Samee
- Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Adhir Shroff
- University of Illinois-Chicago, Chicago, IL, United States
| | - Lloyd W Klein
- Wayne State University/Detroit Medical Center, Detroit, MI, United States.,University of California, San Francisco, San Francisco, CA, United States
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Liang FW, Lee JC, Lu TH, Yin WH. Trends in proportions of hospitals and operators not meeting minimum percutaneous coronary intervention volume standards in Taiwan, 2001-2013. Catheter Cardiovasc Interv 2017; 92:247-250. [PMID: 28963782 DOI: 10.1002/ccd.27343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine trends in proportions of hospitals and operators not meeting the minimum percutaneous coronary intervention (PCI) volume standards in Taiwan during 2001-2013. BACKGROUND The 2013 Clinical Competence Statement recommends that operators perform a minimum of ≥50 PCIs annually (averaged over a 2-year period) in hospitals conducting ≥200 PCIs annually. METHODS Taiwan National Health Insurance claims data from 2001 to 2013 are used to determine the annual numbers of PCIs performed by each hospital and operator. RESULTS The percentage of hospitals conducting annual PCI volumes of <200 decreased from 57% (26/46) in 2001 to 39% (29/74) in 2007 and 33% (33/91) in 2013; the percentage of operators conducting PCI volumes <50 annually remained relatively constant at 60% (146/243) in 2001, 60% (270/452) in 2007, and 58% (354/611) in 2013; and the percentage of operators conducting low volumes (<50) in low-volume hospitals (<200) decreased from 24% (57/243) in 2001 to 15% (66/452) in 2007 and 12% (76/611) in 2013. CONCLUSIONS Approximately one-third of hospitals and three-fifths of operators in Taiwan failed to meet minimum PCI volume standards. Further research examining patient outcomes from PCIs performed by low-volume hospitals and operators is recommended.
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Affiliation(s)
- Fu-Weng Liang
- The NCKU Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jo-Chi Lee
- The NCKU Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- The NCKU Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Hsian Yin
- Division of Cardiology, Heart Center, Cheng Hsin General Hospital, and Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
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Chui PW, Parzynski CS, Nallamothu BK, Masoudi FA, Krumholz HM, Curtis JP. Hospital Performance on Percutaneous Coronary Intervention Process and Outcomes Measures. J Am Heart Assoc 2017; 6:JAHA.116.004276. [PMID: 28446493 PMCID: PMC5524055 DOI: 10.1161/jaha.116.004276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Physician Consortium for Performance Improvement recently proposed percutaneous coronary intervention (PCI)-specific process measures. However, information about hospital performance on these measures and the association of PCI process and outcomes measures are not available. METHODS AND RESULTS We linked the National Cardiovascular Data Registry (NCDR) CathPCI Registry with Medicare claims data to assess hospital performance on established PCI process measures (aspirin, thienopyridines, and statins on discharge; door-to-balloon time; and referral to cardiac rehabilitation), newly proposed PCI process measures (documentation of contrast dose, glomerular filtration rate, and PCI indication; appropriate indication for elective PCI; and use of embolic protection device), and a composite of all process measures. We calculated weighted pair-wise correlations between each set of process metrics and performed weighted correlation analyses to assess the association between composite measure performance with corresponding 30-day risk-standardized mortality and readmission rates. We reported the variance in risk-standardized 30-day outcome rates explained by process measures. We analyzed 1 268 860 PCIs from 1331 hospitals. For many process measures, median hospital performance exceeded 90%. We found strong correlations between medication-specific process measures (P<0.01) and weak correlations between hospital performance on the newly proposed and established process measures. The composite process measure explained only 1.3% and 2.0% of the observed variation in mortality and readmission rates, respectively. CONCLUSIONS Hospital performance on many PCI-specific process measures demonstrated little opportunity for improvement and explained only a small percentage of hospital variation in 30-day outcomes. Efforts to measure and improve hospital quality for PCI patients should focus on both process and outcome measures.
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Affiliation(s)
- Philip W Chui
- Department of Internal Medicine, University of California Irvine School of Medicine, Orange, CA
| | - Craig S Parzynski
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Brahmajee K Nallamothu
- Center for Clinical Management Research, Ann Arbor VA Medical Center, University of Michigan Medical School, Ann Arbor, MI.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Frederick A Masoudi
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Jeptha P Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT .,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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Klein LW, Harjai KJ, Resnic F, Weintraub WS, Vernon Anderson H, Yeh RW, Feldman DN, Gigliotti OS, Rosenfeld K, Duffy P. 2016 Revision of the SCAI position statement on public reporting. Catheter Cardiovasc Interv 2016; 89:269-279. [PMID: 27755653 DOI: 10.1002/ccd.26818] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/08/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Fred Resnic
- Lahey Hospital and Medical Center, Burlington, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | | | - H Vernon Anderson
- University of Texas Health Science Center Houston, McGovern Medical School, Houston, Texas
| | - Robert W Yeh
- Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Dmitriy N Feldman
- New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | | | - Kenneth Rosenfeld
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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8
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Cavender MA, Joynt KE, Parzynski CS, Resnic FS, Rumsfeld JS, Moscucci M, Masoudi FA, Curtis JP, Peterson ED, Gurm HS. State mandated public reporting and outcomes of percutaneous coronary intervention in the United States. Am J Cardiol 2015; 115:1494-501. [PMID: 25891991 DOI: 10.1016/j.amjcard.2015.02.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/26/2015] [Accepted: 02/26/2015] [Indexed: 12/26/2022]
Abstract
Public reporting has been proposed as a strategy to improve health care quality. Percutaneous coronary interventions (PCIs) performed in the United States from July 1, 2009, to June 30, 2011, included in the CathPCI Registry were identified (n = 1,340,213). Patient characteristics and predicted and observed in-hospital mortality were compared between patients treated with PCI in states with mandated public reporting (Massachusetts, New York, Pennsylvania) and states without mandated public reporting. Most PCIs occurred in states without mandatory public reporting (88%, n = 1,184,544). Relative to patients treated in nonpublic reporting states, those who underwent PCI in public reporting states had similar predicted in-hospital mortality (1.39% vs 1.37%, p = 0.17) but lower observed in-hospital mortality (1.19% vs 1.41%, adjusted odds ratio [ORadj] 0.80; 95% confidence interval [CI] 0.74, 0.88; p <0.001). In patients for whom outcomes were available at 180 days, the differences in mortality persisted (4.6% vs 5.4%, ORadj 0.85, 95% CI 0.79 to 0.92, p <0.001), whereas there was no difference in myocardial infarction (ORadj 0.97, 95% CI 0.89 to 1.07) or revascularization (ORadj 1.05, 95% CI 0.92 to 1.20). Hospital readmissions were increased at 180 days in patients who underwent PCI in public reporting states (ORadj 1.08, 95% CI 1.03 to 1.12, p = 0.001). In conclusion, patients who underwent PCI in states with mandated public reporting of outcomes had similar predicted risks but significantly lower observed risks of death during hospitalization and in the 6 months after PCI. These findings support considering public reporting as a potential strategy for improving outcomes of patients who underwent PCI although further studies are warranted to delineate the reasons for these differences.
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Affiliation(s)
- Matthew A Cavender
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Karen E Joynt
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard School of Public Health, VA Boston Healthcare System, Boston, Massachusetts
| | - Craig S Parzynski
- Yale Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
| | | | | | | | | | - Jeptha P Curtis
- Yale Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
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Jennings HS, Rao SV, Feldman DN, Kolansky DM, Kutcher MA, Baker NC, Chambers CE, Petit CJ, Cigarroa JE. SCAI core curriculum for adult and pediatric interventional fellowship training in continuous quality assessment and improvement. Catheter Cardiovasc Interv 2015; 86:422-31. [PMID: 25950289 DOI: 10.1002/ccd.26029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Henry S Jennings
- Division of Cardiovascular Medicine, Vanderbilt Heart & Vascular Institute, Nashville, Tennessee
| | - Sunil V Rao
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Dmitriy N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Daniel M Kolansky
- Penn Heart and Vascular Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael A Kutcher
- Division of Cardiology, Wake Forest School of Medicine, Winstom-Salem, North Carolonia
| | | | | | - Christopher J Petit
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Joaquin E Cigarroa
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health and Sciences University, Portland, Oregon
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Dehmer GJ, Blankenship JC, Cilingiroglu M, Dwyer JG, Feldman DN, Gardner TJ, Grines CL, Singh M. SCAI/ACC/AHA Expert Consensus Document: 2014 Update on Percutaneous Coronary Intervention Without On-Site Surgical Backup. Catheter Cardiovasc Interv 2015; 84:169-87. [PMID: 25045090 DOI: 10.1002/ccd.25371] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 12/21/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Gregory J Dehmer
- Baylor Scott & White Health, Central Texas, Temple, TX. SCAI Writing Committee Member and Chair
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Singh M, Lennon RJ, Gulati R, Holmes DR. Risk scores for 30-day mortality after percutaneous coronary intervention: new insights into causes and risk of death. Mayo Clin Proc 2014; 89:631-7. [PMID: 24797644 DOI: 10.1016/j.mayocp.2014.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/28/2014] [Accepted: 03/18/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the causes and risk of death after percutaneous coronary interventions (PCIs) and to compare the discriminatory ability of the New York State Risk Score (NYSRS) with the Mayo Clinic Risk Score (MCRS). PATIENTS AND METHODS We studied in-hospital and 30-day mortality after PCI in 4898 patients treated at Mayo Clinic in Rochester, Minnesota, from January 1, 2007, through December 31, 2010, to validate the NYSRS equation with recalibrated predicted probabilities of death. RESULTS Of the 4898 patients studied, 93 (1.9%) died during the index hospitalization, and 36 (0.7%) died within 30 days after discharge. For the in-hospital and 30-day mortality, respectively, the area under the receiver operating characteristic curve was 0.92 and 0.88 for the NYSRS and 0.93 and 0.90 for the MCRS, indicating excellent discrimination. The NYSRS model underpredicted event rates when applied in Mayo Clinic data (2.6% observed [127 of 4898 patients] vs 2.3% predicted [114 of 4898 patients]), even after recalibration. The instantaneous hazard over time revealed the highest risk of death in the first 3 days after PCI (daily probability, >0.2%), declined to 0.1% until about day 12, and then decreased below 0.1%. Cardiac causes (mainly myocardial infarction) dominated in the first week (83 of 85 deaths [97.6%]) and then decreased to 59.5% (25 of 42 deaths) between 8 and 30 days after PCI. CONCLUSION The discriminatory ability of the NYSRS and the MCRS for in-hospital and 30-day mortality after PCI is roughly interchangeable. The risk of death is highest during the first 2 weeks and is dominated by cardiac causes of death.
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Affiliation(s)
- Mandeep Singh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - David R Holmes
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Dehmer GJ, Blankenship JC, Cilingiroglu M, Dwyer JG, Feldman DN, Gardner TJ, Grines CL, Singh M. SCAI/ACC/AHA Expert Consensus Document: 2014 update on percutaneous coronary intervention without on-site surgical backup. J Am Coll Cardiol 2014; 63:2624-2641. [PMID: 24651052 DOI: 10.1016/j.jacc.2014.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Klein LW. How do interventional cardiologists make decisions?: implications for practice and reimbursement. JACC Cardiovasc Interv 2013; 6:989-91. [PMID: 24050872 DOI: 10.1016/j.jcin.2013.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 02/12/2013] [Accepted: 02/15/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Lloyd W Klein
- Department of Medicine, Cardiology Section, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
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14
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Dehmer GJ. Public Reporting in Interventional Cardiology. JACC Cardiovasc Interv 2013; 6:631-3. [DOI: 10.1016/j.jcin.2013.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/15/2013] [Indexed: 11/16/2022]
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Risk-Adjusted Models of 30-Day Mortality Following Coronary Intervention. JACC Cardiovasc Interv 2013; 6:623-4. [DOI: 10.1016/j.jcin.2013.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/15/2013] [Indexed: 11/23/2022]
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Gillebert TC, Drieghe B, De Buyzere ML. Is myocardial revascularization safe in trainees' hands? Eur Heart J 2013; 34:2859-61. [DOI: 10.1093/eurheartj/eht177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Seto A, Kern MJ. Declining pci volume: does low volume mean low quality? Catheter Cardiovasc Interv 2012; 81:40-1. [DOI: 10.1002/ccd.24748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 11/13/2012] [Indexed: 11/07/2022]
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Smith IR, Cameron J, Mengersen KL, Foster KA, Rivers JT. Risk modelling in quality clinical registries: monitoring lesion treatment failure rate in percutaneous coronary interventions. Heart Lung Circ 2012; 22:193-203. [PMID: 23154197 DOI: 10.1016/j.hlc.2012.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/29/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
AIMS This paper describes the development of a risk adjustment (RA) model predictive of individual lesion treatment failure in percutaneous coronary interventions (PCI) for use in a quality monitoring and improvement program. METHODS AND RESULTS Prospectively collected data for 3972 consecutive revascularisation procedures (5601 lesions) performed between January 2003 and September 2011 were studied. Data on procedures to September 2009 (n=3100) were used to identify factors predictive of lesion treatment failure. Factors identified included lesion risk class (p<0.001), occlusion type (p<0.001), patient age (p=0.001), vessel system (p<0.04), vessel diameter (p<0.001), unstable angina (p=0.003) and presence of major cardiac risk factors (p=0.01). A Bayesian RA model was built using these factors with predictive performance of the model tested on the remaining procedures (area under the receiver operating curve: 0.765, Hosmer-Lemeshow p value: 0.11). Cumulative sum, exponentially weighted moving average and funnel plots were constructed using the RA model and subjectively evaluated. CONCLUSION A RA model was developed and applied to SPC monitoring for lesion failure in a PCI database. If linked to appropriate quality improvement governance response protocols, SPC using this RA tool might improve quality control and risk management by identifying variation in performance based on a comparison of observed and expected outcomes.
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Affiliation(s)
- Ian R Smith
- St Andrew's Medical Institute, St Andrew's War Memorial Hospital, Wickham Terrace, Brisbane, Queensland 4000, Australia
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Naidu SS, Rao SV, Blankenship J, Cavendish JJ, Farah T, Moussa I, Rihal CS, Srinivas VS, Yakubov SJ. Clinical expert consensus statement on best practices in the cardiac catheterization laboratory: Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2012; 80:456-64. [PMID: 22434598 DOI: 10.1002/ccd.24311] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 11/30/2011] [Accepted: 12/24/2011] [Indexed: 11/09/2022]
Affiliation(s)
- Srihari S Naidu
- Division of Cardiology, Winthrop University Hospital, Mineola, New York, USA.
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Frey P, Connors A, Resnic FS. Quality Measurement and Improvement in the Cardiac Catheterization Laboratory. Circulation 2012; 125:615-9. [DOI: 10.1161/circulationaha.111.018234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paul Frey
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ann Connors
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Frederic S. Resnic
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
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