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Saito Y, Inohara T, Kohsaka S, Wada H, Kumamaru H, Yamaji K, Ishii H, Amano T, Miyata H, Kobayashi Y, Kozuma K. Benchmarking System Monitoring on Quality Improvement in Percutaneous Coronary Intervention: A Nationwide Registry in Japan. JACC. ASIA 2024; 4:323-331. [PMID: 38660107 PMCID: PMC11035937 DOI: 10.1016/j.jacasi.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 04/26/2024]
Abstract
Background Quality indicators (QIs) have been developed to improve and standardize care quality in percutaneous coronary intervention (PCI). In Japan, consecutive PCI procedures are registered in a nationwide database (the Japanese Percutaneous Coronary Intervention registry), which introduces a benchmarking system for comparing individual institutional performance against the national average. Objectives The aim of this study was to assess the impact of the benchmarking system implementation on QI improvement at the hospital level. Methods A total of 734,264 PCIs were conducted at 1,194 institutions between January 2019 and December 2021. In January 2018, a web-based benchmarking system encompassing 7 QIs for PCI at the institutional level, including door-to-balloon time and rate of transradial intervention, was introduced. The process by which institutions tracked their QIs was centrally monitored. Results During the 3-year study period, the benchmarking system was reviewed at least once at 742 institutions (62.1%) (median 4 times; Q1-Q3: 2-7 times). The institutions that reviewed their records had higher PCI volumes. Among these institutions, although door-to-balloon time was not directly associated, the proportion of transradial intervention increased by 2.3% in the system review group during the initial year compared with 0.7% in their counterparts. However, in the subsequent year, the association between system reviews and QI improvement was attenuated. Conclusions The implementation of a benchmarking system, reviewed by participating institutions in Japan, was partially associated with improved QIs during the first year; however, this improvement was attenuated in the subsequent year, highlighting the need for further efforts to develop effective and sustainable interventions to enhance care quality in PCI.
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Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kyohei Yamaji
- Department of Cardiology, Kyoto University, Kyoto, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - J-PCI Registry Investigators
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Japan
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Cardiology, Kyoto University, Kyoto, Japan
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
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Dehmer GJ, Grines CL, Bakaeen FG, Beasley DL, Beckie TM, Boyd J, Cigarroa JE, Das SR, Diekemper RL, Frampton J, Hess CN, Ijioma N, Lawton JS, Shah B, Sutton NR. 2023 AHA/ACC Clinical Performance and Quality Measures for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures. J Am Coll Cardiol 2023; 82:1131-1174. [PMID: 37516946 DOI: 10.1016/j.jacc.2023.03.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
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3
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Ho PM, O’Donnell CI, McCreight M, Bavry AA, Bosworth HB, Girotra S, Grossman PM, Helfrich C, Latif F, Lu D, Matheny M, Mavromatis K, Ortiz J, Parashar A, Ratliff DM, Grunwald GK, Gillette M, Jneid H. Multifaceted Intervention to Improve P2Y12 Inhibitor Adherence After Percutaneous Coronary Intervention: A Stepped Wedge Trial. J Am Heart Assoc 2022; 11:e024342. [PMID: 35766258 PMCID: PMC9333389 DOI: 10.1161/jaha.121.024342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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 P2Y12 inhibitor medications are critical following percutaneous coronary intervention (PCI); however, adherence remains suboptimal. Our objective was to assess the effectiveness of a multifaceted intervention to improve P2Y12 inhibitor adherence following PCI. Methods and Results This was a modified stepped wedge trial of 52 eligible hospitals, of which 15 were randomly selected and agreed to participate (29 hospitals declined, and 8 eligible hospitals were not contacted). At each intervention hospital, patient recruitment occurred for 6 months and enrolled patients were followed up for 1 year after PCI. Three control groups were used: patients at intervention hospitals undergoing PCI (1) before the intervention period (preintervention); (2) after the intervention period (postintervention); or (3) at the 8 hospitals not contacted (concurrent controls). The intervention consisted of 4 components: (1) P2Y12 inhibitor delivered to patients' bedside after PCI; (2) education on importance of P2Y12 inhibitors; (3) automated reminder telephone calls to refill medication; and (4) outreach to patients if they delayed refilling P2Y12 inhibitor. The primary outcomes were as follows: (1) proportion of patients with delays filling P2Y12 inhibitor at hospital discharge and (2) proportion of patients who were adherent in the year after PCI using pharmacy refill data. Primary analysis compared intervention with preintervention control patients. There were 1377 (intent-to-treat) potentially eligible patients, of whom 803 (per protocol) were approached at intervention sites versus 5910 preintervention, 2807 postintervention, and 4736 concurrent control patients. In the intent-to-treat analysis, intervention patients were less likely to delay filling P2Y12 at hospital discharge (-3.4%; 98.3% CI, -1.2% to -5.6%) and more likely to be adherent to P2Y12 (4.1%; 98.3% CI, 1.0%-7.1%) at 1 year, but had more clinical events (3.2%; 98.3% CI, 2.3%-4.1%) driven by repeated PCI compared with preintervention patients. In post hoc analysis looking at myocardial infarction, stroke, and death, intervention patients had lower event rates compared with preintervention patients (-1.7%; 98.3% CI, -2.3% to -1.1%). Conclusions A 4-component intervention targeting P2Y12 inhibitor adherence was difficult to implement. The intervention produced mixed results. It improved P2Y12 adherence, but there was also an increase in repeat PCI. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01609842.
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Affiliation(s)
- P. Michael Ho
- Cardiology SectionRocky Mountain Regional VA Medical CenterAuroraCO,Department of MedicineUniversity of Colorado School of MedicineAuroraCO,Denver‐Seattle Center of Innovation for Veteran Centered and Value Driven CareRocky Mountain Regional VA Medical CenterAuroraCO
| | | | - Marina McCreight
- Denver‐Seattle Center of Innovation for Veteran Centered and Value Driven CareRocky Mountain Regional VA Medical CenterAuroraCO
| | | | - Hayden B. Bosworth
- Departments of Population Health Science, Medicine, Psychiatry, School of NursingDuke University School of MedicineDurhamNC,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)Durham VAMCDurhamNC
| | - Saket Girotra
- University of Iowa Carver College of MedicineIowa CityIA,Iowa City Veterans Affairs Medical CenterIowa CityIA
| | | | - Christian Helfrich
- Seattle‐Denver Center of Innovation for Veteran Centered and Value Driven CarePuget Sound Health Care SystemSeattleWA
| | - Faisal Latif
- Oklahoma City VA Health Care SystemOklahoma CityOK,University of Oklahoma Health Sciences CenterOklahoma CityOK
| | - David Lu
- Washington DC VA Medical CenterWashingtonDC
| | - Michael Matheny
- Geriatric ResearchEducation, and Clinical Care CenterTennessee Valley Healthcare System VANashvilleTN,Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTN
| | | | - Jose Ortiz
- VA Northeast Ohio Healthcare SystemClevelandOH
| | - Amitabh Parashar
- Virginia Tech Carilion School of MedicineRoanokeVA,Salem VA Medical CenterSalemVA
| | | | - Gary K. Grunwald
- Denver‐Seattle Center of Innovation for Veteran Centered and Value Driven CareRocky Mountain Regional VA Medical CenterAuroraCO,University of Colorado School of Public HealthAuroraCO
| | - Michael Gillette
- Baylor College of MedicineHoustonTX,Michael E. DeBakey VA Medical CenterHoustonTX
| | - Hani Jneid
- Baylor College of MedicineHoustonTX,Michael E. DeBakey VA Medical CenterHoustonTX
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4
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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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5
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Stys A, Gedela M, Bhatnagar U, Petrasko M, Dawoud H, Malinski T, Stys T. A prospective study of contrast preservation using ultra-low contrast delivery technique versus standard automated contrast injector system in coronary procedures. Indian Heart J 2019; 71:297-302. [PMID: 31779856 PMCID: PMC6890984 DOI: 10.1016/j.ihj.2019.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/29/2019] [Accepted: 09/01/2019] [Indexed: 12/22/2022] Open
Abstract
Background We aimed to assess the decrease in contrast media volume (CMV) with ultra-low contrast delivery technique (ULCD) developed at our institution versus the usual automated contrast injector system (ACIS) contrast delivery in coronary procedures. Methods We analyzed the amount of contrast given in the consecutive 204 patients of the operators who use ULCD technique versus consecutive 200 patients of the other operators who use ACIS without ULCD technique for coronary angiograms and/or percutaneous coronary interventions (PCIs) from May 2017 to July 2018 at our center. We calculated the mean CMV between these groups. Results We observed a significant reduction in mean CMV with ULCD technique versus standard ACIS, respectively: angiogram 24.8 ± 15.8 mL (n = 194) vs 42.3 ± 25.1 mL (n = 200) (p < 0.0001); PCI 23.5 ± 19.7 mL (n = 52) vs 48.2 ± 30.8 mL (n = 16) (p < 0.0070); angiogram with ad hoc PCI 53.4 ± 32.1 mL (n = 23) vs 89.7 ± 35.6 mL (n = 16) (p < 0.0024); and overall angiogram and PCI 27.4 ± 20.5 mL (n = 204) vs 44.9 ± 28.0 mL (n = 181) (p < 0.0001). Conclusion Our study showed a highly significant reduction in CMV using ULCD technique compared to standard ACIS contrast delivery in coronary invasive procedures. Even in the standard ACIS arm, CMV was significantly lower than values reported in literature, possibly due to operators' bias toward contrast preservation.
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Affiliation(s)
- Adam Stys
- Sanford Heart Hospital, Sanford Cardiovascular Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, 57105, USA
| | - Maheedhar Gedela
- Sanford Heart Hospital, Sanford Cardiovascular Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, 57105, USA.
| | - Udit Bhatnagar
- Sanford Heart Hospital, Sanford Cardiovascular Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, 57105, USA
| | - Marian Petrasko
- Sanford Heart Hospital, Sanford Cardiovascular Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, 57105, USA
| | - Hazem Dawoud
- Nanomedical Research Laboratory, Ohio University, Athens, OH, 45701, USA
| | - Tadeusz Malinski
- Nanomedical Research Laboratory, Ohio University, Athens, OH, 45701, USA
| | - Tomasz Stys
- Sanford Heart Hospital, Sanford Cardiovascular Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, 57105, USA
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6
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Abstract
Risk-adjusted mortality has been proposed as a quality of care indicator to gauge cardiovascular intensive care Unit (CICU) performance. Mortality is easily measured, readily understandable, and a meaningful outcome for the patient, provider, administrative agencies, and other key stakeholders. Disease-specific risk-adjusted mortality is commonly used in cardiovascular medicine as an indicator of care quality, for external accreditation, and to determine payer reimbursement. However, the evidence base for overall risk-adjusted mortality in the CICU is limited, with most available data coming from the general critical care literature. In addition, existing risk-adjusted mortality models vary considerably in terms of approach and composition, and there is no nationally recognized standard. Thus, the objective of this study was to review the use of risk-adjusted mortality as a measure of overall unit performance and quality of care in the CICU. We found a considerable variability in the risk-adjustment methodology for cardiovascular disease. Although predictive models for disease-specific risk-adjusted mortality in cardiovascular disease have been developed, there are limited published data on overall risk-adjusted mortality for the CICU. Without standardization of risk-adjustment methodology, researchers are often required to use existing risk-adjustment models developed in noncardiac patient populations. Further studies are needed to establish whether risk-adjusted overall CICU mortality is a valid performance measure and whether it reflects care quality.
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7
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Reed GW, Tushman ML, Kapadia SR. Operational Efficiency and Effective Management in the Catheterization Laboratory. J Am Coll Cardiol 2018; 72:2507-2517. [DOI: 10.1016/j.jacc.2018.08.2179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/01/2018] [Accepted: 08/15/2018] [Indexed: 10/27/2022]
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8
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Desch S, Fuernau G, Pöss J, Meyer-Saraei R, Saad M, Eitel I, Thiele H, de Waha S. Impact of a novel contrast reduction system on contrast savings in coronary angiography – The DyeVert randomised controlled trial. Int J Cardiol 2018; 257:50-53. [DOI: 10.1016/j.ijcard.2017.12.107] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/21/2017] [Accepted: 12/29/2017] [Indexed: 12/01/2022]
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9
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Lim HS, Seo KW, Yoon MH, Yang HM, Tahk SJ. Ischemia-based Coronary Revascularization: Beyond Anatomy and Fractional Flow Reserve. Korean Circ J 2018; 48:16-23. [PMID: 29171198 PMCID: PMC5764867 DOI: 10.4070/kcj.2017.0177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/07/2017] [Accepted: 09/11/2017] [Indexed: 11/23/2022] Open
Abstract
Treatment strategies for patients with coronary artery disease (CAD) should be based on objective evidence of inducible ischemia in the subtended myocardium to improve clinical outcomes, symptoms, and cost-effectiveness. Fractional flow reserve (FFR) is the most verified index to-date for invasively evaluating lesion-specific myocardial ischemia. Favorable results from large clinical trials that applied FFR-guided percutaneous coronary intervention (PCI) prompted changes in coronary revascularization guidelines to emphasize the importance of this ischemia-based strategy using invasive coronary physiology. However, the frequency of functional evaluations is lacking in daily practice, and visual assessment still dominates treatment decisions in CAD patients. Despite recent efforts to integrate functional and anatomical assessments for coronary stenosis, there is considerable discordance between the 2 modalities, and the diagnostic accuracy of simple parameters obtained from current imaging tools is not satisfactory to determine functional significance. Although evidence that supports or justifies anatomy-guided PCI is more limited, and FFR-guided PCI is currently recommended, it is important to be aware of conditions and factors that influence FFR for accurate interpretation and application. In this article, we review the limitations of the current anatomy-derived evaluation of the functional significance of coronary stenosis, detail considerations for the clinical utility of FFR, and discuss the importance of an integrated physiologic approach to determine treatment strategies for CAD patients.
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Affiliation(s)
- Hong Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Kyoung Woo Seo
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Myeong Ho Yoon
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Hyoung Mo Yang
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Seung Jea Tahk
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
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10
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Leonardi S, Marino M, Crimi G, Maiorana F, Rizzotti D, Lettieri C, Bettari L, Zuccari M, Sganzerla P, Tresoldi S, Adamo M, Ghiringhelli S, Sponzilli C, Pasquetto G, Pavei A, Pedon L, Bassan L, Bollati M, Camisasca P, Trabattoni D, Brancati M, Poli A, Panciroli C, Lettino M, Tarelli G, Tarantini G, De Luca L, Varbella F, Musumeci G, De Servi S. APpropriAteness of percutaneous Coronary interventions in patients with ischaemic HEart disease in Italy: the APACHE pilot study. BMJ Open 2017; 7:e016909. [PMID: 28877948 PMCID: PMC5588962 DOI: 10.1136/bmjopen-2017-016909] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To first explore in Italy appropriateness of indication, adherence to guideline recommendations and mode of selection for coronary revascularisation. DESIGN Retrospective, pilot study. SETTING 22 percutaneous coronary intervention (PCI)-performing hospitals (20 patients per site), 13 (59%) with on-site cardiac surgery. PARTICIPANTS 440 patients who received PCI for stable coronary artery disease (CAD) or non-ST elevation acute coronary syndrome were independently selected in a 4:1 ratio with half diabetics. PRIMARY AND SECONDARY OUTCOME MEASURES Proportion of patients who received appropriate PCI using validated appropriate use scores (ie, AUS≥7). Also, in patients with stable CAD, we examined adherence to the following European Society of Cardiology recommendations: (A) per cent of patients with complex coronary anatomy treated after heart team discussion; (B) per cent of fractional flow reserve-guided PCI for borderline stenoses in patients without documented ischaemia; (C) per cent of patients receiving guideline-directed medical therapy at the time of PCI as well as use of provocative test of ischaemia according to pretest probability (PTP) of CAD. RESULTS Of the 401 mappable PCIs (91%), 38.7% (95% CI 33.9 to 43.6) were classified as appropriate, 47.6% (95% CI 42.7 to 52.6) as uncertain and 13.7% (95% CI 10.5% to 17.5%) as inappropriate. Median PTP in patients with stable CAD without known coronary anatomy was 69% (78% intermediate PTP, 22% high PTP). Ischaemia testing use was similar (p=0.71) in patients with intermediate (n=140, 63%) and with high PTP (n=40, 66%). In patients with stable CAD (n=352) guideline adherence to the three recommendations explored was: (A) 11%; (B) 25%; (C) 23%. AUS was higher in patients evaluated by the heart team as compared with patients who were not (7 (6.8) vs 5 (4.7); p=0.001). CONCLUSIONS Use of heart team approaches and adherence to guideline recommendations on coronary revascularisation in a real-world setting is limited. This pilot study documents the feasibility of measuring appropriateness and guideline adherence in clinical practice and identifies substantial opportunities for quality improvement. TRIAL REGISTRATION NUMBER NCT02748603.
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Affiliation(s)
- Sergio Leonardi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Gabriele Crimi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Florinda Maiorana
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Diego Rizzotti
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Luca Bettari
- Cardiology, ASST Cremona–Ospedale di Cremona, Cremona, Italy
| | - Marco Zuccari
- Cardiology, Ospedale Fornaroli di Magenta, Magenta, Italy
| | - Paolo Sganzerla
- Cardiology, ASST Bergamo Ovest–Ospedale di Treviglio, Treviglio, Italy
| | - Simone Tresoldi
- Cardiology, Azienda Ospedaliera di Desio e Vimercate, Vimercate, Italy
| | | | | | | | - Giampaolo Pasquetto
- Cardiology, Ospedali Riuniti Padova Sud Madre Teresa di Calcutta, Monselice, Italy
| | - Andrea Pavei
- Cardiology, Presidio Ospedaliero di Conegliano, Conegliano, Italy
| | - Luigi Pedon
- Cardiology, Presidio Ospedaliero di Cittadella, Cittadella, Italy
| | | | - Mario Bollati
- Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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11
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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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12
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Cost NG. Editorial Comment. J Urol 2016; 197:36. [PMID: 27664514 DOI: 10.1016/j.juro.2016.07.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Nicholas G Cost
- Department of Surgery, Division of Urology, University of Colorado Cancer Center and University of Colorado School of Medicine, Aurora, Colorado
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13
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Affiliation(s)
- Michael E Porter
- From Harvard Business School (M.E.P.), the Boston Consulting Group (S.L.), Press Ganey (T.H.L.), and Harvard Medical School (T.H.L.) - all in Boston
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14
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Aspry K, Wu WC, Salmoirago-Blotcher E. Cardiac Rehabilitation in Patients with Established Atherosclerotic Vascular Disease: New Directions in the Era of Value-Based Healthcare. Curr Atheroscler Rep 2016; 18:10. [PMID: 26803511 DOI: 10.1007/s11883-016-0561-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Exercise-based cardiac rehabilitation (CR) is associated with significant improvements in coronary disease outcomes, but has been underutilized. However, new developments within the field, some spurred by healthcare reform and the transition to more accountable and coordinated care, offer hope for closing the large CR treatment gap. This review presents new CR-related research, policy, and analyses, and discusses how evolving eligibility criteria, referral processes, performance measures, care models, and delivery and payment options could increase CR utilization over the next decade and enable this life-saving secondary prevention intervention to thrive in the era of value-based health care.
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Affiliation(s)
- Karen Aspry
- Alpert Medical School of Brown University, Providence, RI, USA. .,Lifespan Cardiovascular Institute, Providence, RI, USA. .,Center for Cardiac Fitness, Miriam Hospital, Providence, RI, USA. .,Lifespan Cardiovascular Institute, 1454 South County Trail-Suite 200, East Greenwich, RI, 02818, USA.
| | - Wen-Chih Wu
- Alpert Medical School of Brown University, Providence, RI, USA.,Lifespan Cardiovascular Institute, Providence, RI, USA.,Center for Cardiac Fitness, Miriam Hospital, Providence, RI, USA.,Providence VA Medical Center, Providence, RI, USA
| | - Elena Salmoirago-Blotcher
- Alpert Medical School of Brown University, Providence, RI, USA.,Center for Preventive and Behavioral Medicine, Miriam Hospital, Providence, RI, USA
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15
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2015 ACC/AHA Focused Update of Secondary Prevention Lipid Performance Measures: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol 2015; 67:558-87. [PMID: 26698405 DOI: 10.1016/j.jacc.2015.02.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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López-Sendón J, González-Juanatey JR, Pinto F, Cuenca Castillo J, Badimón L, Dalmau R, González Torrecilla E, López-Mínguez JR, Maceira AM, Pascual-Figal D, Pomar Moya-Prats JL, Sionis A, Zamorano JL. Indicadores de calidad en cardiología. Principales indicadores para medir la calidad de los resultados (indicadores de resultados) y parámetros de calidad relacionados con mejores resultados en la práctica clínica (indicadores de práctica asistencial). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): Declaración de posicionamiento de consenso de SEC/SECTCV. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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López-Sendón J, González-Juanatey JR, Pinto F, Cuenca Castillo J, Badimón L, Dalmau R, González Torrecilla E, López-Mínguez JR, Maceira AM, Pascual-Figal D, Pomar Moya-Prats JL, Sionis A, Zamorano JL. Indicadores de calidad en cardiología. Principales indicadores para medir la calidad de los resultados (indicadores de resultados) y parámetros de calidad relacionados con mejores resultados en la práctica clínica (indicadores de práctica asistencial). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): Declaración de posicionamiento de consenso de SEC/SECTCV. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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López-Sendón J, González-Juanatey JR, Pinto F, Cuenca Castillo J, Badimón L, Dalmau R, González Torrecilla E, López-Mínguez JR, Maceira AM, Pascual-Figal D, Pomar Moya-Prats JL, Sionis A, Zamorano JL. Quality Markers in Cardiology. Main Markers to Measure Quality of Results (Outcomes) and Quality Measures Related to Better Results in Clinical Practice (Performance Metrics). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): A SEC/SECTCV Consensus Position Paper. ACTA ACUST UNITED AC 2015; 68:976-995.e10. [PMID: 26315766 DOI: 10.1016/j.rec.2015.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/21/2015] [Indexed: 02/06/2023]
Abstract
Cardiology practice requires complex organization that impacts overall outcomes and may differ substantially among hospitals and communities. The aim of this consensus document is to define quality markers in cardiology, including markers to measure the quality of results (outcomes metrics) and quality measures related to better results in clinical practice (performance metrics). The document is mainly intended for the Spanish health care system and may serve as a basis for similar documents in other countries.
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Affiliation(s)
- José López-Sendón
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain.
| | - José Ramón González-Juanatey
- Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Fausto Pinto
- European Society of Cardiology; Department of Cardiology, University Hospital Santa Maria, Lisbon, Portugal
| | - José Cuenca Castillo
- Sociedad Española de Cirugía Torácica-Cardiovascular; Servicio de Cirugía Cardiaca, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Lina Badimón
- Centro de Investigación Cardiovascular (CSIC-ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Regina Dalmau
- Unidad de Rehabilitación Cardiaca, Servicio de Cardiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Esteban González Torrecilla
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - José Ramón López-Mínguez
- Unidad de Cardiología intervencionista, Servicio de Cardiología, Hospital Infanta Crsitina, Badajoz, Spain
| | - Alicia M Maceira
- Unidad de Imagen Cardiaca, Servicio de Cardiología, ERESA Medical Center, Valencia, Spain
| | - Domingo Pascual-Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Alessandro Sionis
- Unidad de Cuidados Intensivos Cardiológicos, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Luis Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Validation of the appropriate use criteria for percutaneous coronary intervention in patients with stable coronary artery disease (from the COURAGE trial). Am J Cardiol 2015; 116:167-73. [PMID: 25960375 DOI: 10.1016/j.amjcard.2015.03.057] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 11/22/2022]
Abstract
Establishing the validity of appropriate use criteria (AUC) for percutaneous coronary intervention (PCI) in the setting of stable ischemic heart disease can support their adoption for quality improvement. We conducted a post hoc analysis of 2,287 Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation trial patients with stable ischemic heart disease randomized to PCI with optimal medical therapy (OMT) or OMT alone. Within appropriateness categories, we compared rates of death, myocardial infarction, revascularization subsequent to initial therapy, and angina-specific health status as determined by the Seattle Angina Questionnaire in patients randomized to PCI + OMT to those randomized to OMT alone. A total of 1,987 patients (87.9%) were mapped to the 2012 publication of the AUC, with 1,334 (67.1%) classified as appropriate, 551 (27.7%) uncertain, and 102 (5.1%) as inappropriate. There were no significant differences between PCI and OMT alone in the rate of mortality and myocardial infarction by appropriateness classification. Rates of revascularization were significantly lower in patients initially receiving PCI + OMT who were classified as appropriate (hazard ratio 0.65; 95% confidence interval 0.53 to 0.80; p <0.001) or uncertain (hazard ratio 0.49; 95% confidence interval 0.32 to 0.76; p = 0.001). Furthermore, among patients classified as appropriate by the AUC, Seattle Angina Questionnaire scores at 1 month were better in the PCI-treated group compared with the medical therapy group (80 ± 23 vs 75 ± 24 for angina frequency, 73 ± 24 vs 68 ± 24 for physical limitations, and 68 ± 23 vs 60 ± 24 for quality of life; all p <0.01), with differences generally persisting through 12 months. In contrast, health status scores were similar throughout the first year of follow-up in PCI + OMT patients compared with OMT alone in patients classified as uncertain or inappropriate. In conclusion, these findings support the validity of the AUC in efforts to improve health care quality through optimal use of PCI.
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Tang X, Li R, Jing Q, Liu Y, Liu P. Efficacy and Safety of Intracoronary versus Intravenous Administration of Tirofiban during Percutaneous Coronary Intervention for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials. PLoS One 2015; 10:e0129718. [PMID: 26067296 PMCID: PMC4465926 DOI: 10.1371/journal.pone.0129718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/12/2015] [Indexed: 11/19/2022] Open
Abstract
Background Percutaneous coronary intervention (PCI) is known as the most effective treatment for acute coronary syndrome (ACS). However, without proper therapy and patient management, stent thrombosis after PCI may lead to another myocardial infarction. In addition to aspirin and clopidogrel, tirofiban is often used as an antiplatelet therapy in patients with ACS. To date, there has been no comprehensive evaluation of the efficacy and safety of intracoronary (IC) tirofiban administration for ACS patients undergoing PCI compared with intravenous (IV) administration. Therefore, this meta-analysis was conducted to investigate the clinical efficiency and safety of IC versus intravenous (IV) tirofiban in ACS patients undergoing PCI. Methods We searched PubMed and Medline for randomized controlled trials (RCTs) comparing IC versus IV administration of tirofiban in ACS patients undergoing PCI. We evaluated the effects of tirofiban on thrombolysis in myocardial infarction (TIMI) grade 3 flow after PCI, TIMI myocardial perfusion grade 3 (TMP grade 3), left ventricular ejection fraction (LVEF), major adverse cardiovascular events (MACE), target vessel revascularization (TVR), death, reinfarction and adverse drug effects (specifically bleeding events). Results Seven trials involving 1,027 patients were included in this meta-analysis. IC administration of tirofiban significantly increased TIMI grade 3 flow (OR 2.11; 95% CI 1.02 to 4.37; P = 0.04) and TMP grade 3 (OR 2.67; 95% CI 1.09 to 6.49; P = 0.03, I2 = 64%) while reducing MACE (OR 0.46, 95% CI: 0.28 to 0.75; P = 0.002) compared with IV administration of tirofiban. No significant differences were observed in the occurrence of TVR, death, reinfarction and the incidence of bleeding events between the two groups. Conclusions This meta-analysis supports the use of IC over IV administration of tirofiban in patients with ACS to improve TIMI flow, TMP flow and MACE. However, there was no statistically significant difference in the risk of bleeding complications between the two groups.
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Affiliation(s)
- Xiuying Tang
- Department of Cardiology, The first hospital of QinHuangDao, QinHuangDao, HeBei, China
- * E-mail:
| | - Runjun Li
- Department of Emergency Medicine, The first hospital of QinHuangDao, QinHuangDao, HeBei, China
| | - Quanmin Jing
- Department of Cardiology, General Hospital of Shenyang Military Area Command, Shenyang, LiaoNing, China
| | - Yingfeng Liu
- Department of Cardiology, Zhujiang hospital, Southern Medical University, GuangZhou, GuangDong, China
| | - Peng Liu
- Department of Cardiology, Zhujiang hospital, Southern Medical University, GuangZhou, GuangDong, China
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Thomas RJ. The Gap in Cardiac Rehabilitation Referral. J Am Coll Cardiol 2015; 65:2089-90. [DOI: 10.1016/j.jacc.2015.03.521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
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ACC/AHA/SCAI 2014 Health Policy Statement on Structured Reporting for the Cardiac Catheterization Laboratory. J Am Coll Cardiol 2014; 63:2591-2623. [DOI: 10.1016/j.jacc.2014.03.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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