Adherence to process of care quality indicators after percutaneous coronary intervention in Ontario, Canada: a retrospective observational cohort study

Quality assessment in percutaneous coronary interventions: the QERMID Belgian PCI registry

BACKGROUND

The recent increase in the number of interventional cathlabs that followed a moratorium of several years has resulted in an abrupt increase in the number of PCI and a dilution of the experience per centre and per operator.

METHODS

Based on data extracted from the national "Quality Oriented Electronic Registration of Medical Implant Devices" (QERMID) database, we compared the characteristics and outcome of patients treated in 2015 in the 21 newly (<3 years) approved PCI centres with those of patients treated in the 28 historical PCI centres.

RESULTS

The proportion of acute coronary syndromes was slightly higher in new than in historical centres (48% vs. 44%; p < 0.01) but few differences in co-morbidities were observed. Considering separately the patients treated for an acute coronary syndrome or for stable ischaemia, no significant difference in the overall in-hospital or 30-days mortality and in the proportion of same week bypass surgery was observed between newly approved and historical centres. In a substantial proportion (39%) of patients treated for stable angina or silent ischaemia, no test confirming the presence of ischaemia before PCI is reported, without significant difference between new and historical centres.

CONCLUSIONS

Pending the limitations of the QERMID database, including a limited dataset and the absence of systematic on-site monitoring, no significant difference in the rate of major complications was identified between new and historical Belgian PCI centres.

A comparison of rescue and primary percutaneous coronary interventions for acute ST elevation myocardial infarction

Objective

To perform a comparative analysis of in-hospital results obtained from patients with acute ST elevation myocardial infarction (STEMI), who underwent rescue or primary percutaneous coronary intervention (PCI). The aim is to determine rescue PCI as a practical option for patients with no immediate access to primary PCI.

Methods

From the Cardiology PCI Clinic of the National Hospital of Sri Lanka (NHSL), we selected all consecutive patients presenting with acute STEMI </ = 24 h door-to-balloon delay for primary PCI and </ = 72 h door-to-balloon delay, (90 min after failed thrombolysis) for rescue PCI, from March 2013 to April 2015 and their in-hospital results were analyzed, comparing rescue and primary PCI patients.

Results

We evaluated 159 patients; 78 underwent rescue PCI and 81 underwent primary PCI. The culprit left anterior descending (LAD) vessel (76.9% vs. 58.8%; P = 0.015) was more prevalent in rescue than in primary patients. Thrombus aspiration was less frequent in rescue group (19.2% vs. 40.7%; p = 0.004). The degree of moderate-to-severe left ventricular dysfunction reflected by the ejection fraction <40% (24.3% vs. 23.7%; P = 0.927) and prevalence of multivessel disease (41.0% vs. 43.8%; P = 0.729) revealed no significant difference. Coronary stents were implanted at similar rates in both strategies (96.2% vs. 92.6%; P = 0.331). Procedural success (97.4% vs. 97.5%; P = 0.980) and mortality rates (5.1% vs. 3.8%; P = 0.674), were similar in the rescue and primary groups.

Conclusion

In-hospital major adverse cardiac events (MACE) are similar in both rescue and primary intervention groups, supporting the former as a practical option for patients with no immediate access to PCI facilities.

Development of Quality Metrics to Evaluate Pediatric Hematologic Oncology Care in the Outpatient Setting

There are currently no clinic-level quality of care metrics for outpatient pediatric oncology. We sought to develop a list of quality of care metrics for a leukemia-lymphoma (LL) clinic using a consensus process that can be adapted to other clinic settings. Medline-Ovid was searched for quality indicators relevant to pediatric oncology. A provisional list of 27 metrics spanning 7 categories was generated and circulated to a Consensus Group (CG) of LL clinic medical and nursing staff. A Delphi process comprising 2 rounds of ranking generated consensus on a final list of metrics. Consensus was defined as ≥70% of CG members ranking a metric within 2 consecutive scores. In round 1, 19 of 27 (70%) metrics reached consensus. CG members' comments resulted in 4 new metrics and revision of 8 original metrics. All 31 metrics were included in round 2. Twenty-four of 31 (77%) metrics reached consensus after round 2. Thirteen were chosen for the final list based on highest scores and eliminating redundancy. These included: patient communication/education; pain management; delay in access to clinical psychology, documentation of chemotherapy, of diagnosis/extent of disease, of treatment plan and of follow-up scheme; referral to transplant; radiation exposure during follow-up; delay until chemotherapy; clinic cancellations; and school attendance. This study provides a model of quality metric development that other clinics may use for local use. The final metrics will be used for ongoing quality improvement in the LL clinic.

Can Acute Kidney Injury Be Considered a Clinical Quality Measure

Quality indicators are measurements of healthcare outcome, process, or structure that can be used as tools to measure the quality of care and identify opportunities for improvement. Acute kidney injury (AKI) has many characteristics that make it a potential target for quality indicator development. It is common, associated with a high risk of adverse outcomes, and there are reports of gaps in the quality of care in several clinical settings despite publication of evidence-based guidelines. Substantial work has already been undertaken to develop quality measures related to AKI following percutaneous coronary interventions and major surgical procedures. This paper reviews the current literature that has addressed issues of prevention or management of AKI as outcome, process, or structure quality indicators in these clinical settings. Several current controversies about the appropriateness of such indicators related to AKI are identified. Further research to strengthen the evidence-base supporting prevention and management initiatives for AKI across all relevant clinical settings is needed to clarify the role of AKI as a target for clinical quality indicators.