SCAI statement highlights multiple recommendations for evaluating PCI quality at cardiac facilities

Today the Society for Cardiovascular Angiography and Interventions (SCAI) announced the publication of recommendations for assessing and improving program quality at percutaneous coronary intervention (PCI) programs at cardiac facilities. The statement, appearing today in the peer-reviewed journal Catheterization and Cardiovascular Interventions, is the first document to offer guidance regarding core measures for quality and assessment in PCI programs and is the latest tool for interventional cardiologists to use in their ongoing focus on improving patient care.

In an era of health reform, where institutions may soon adopt a "pay-for-performance" model, defined measures of quality have become an increasingly relevant need for PCI programs. In 2005, SCAI, in partnership with the American Heart Association and the American College of Cardiology (ACC), authored guidelines requiring all PCI facilities to evaluate performance through a continuous quality improvement (CQI) process.  SCAI and ACC have also established a catheterization laboratory accreditation program, Accreditation for Cardiovascular Excellence (ACE), designed to help standardize and track quality measures in PCI programs. ACE requires participating programs to establish a CQI process. The statement published today better defines the established set of core quality measures and assessments for institutions with CQI programs.

"This statement demonstrates the interventional cardiology community's dedication to upholding quality standards and continually improving patient care, including what the specific components of a quality improvement program should be," said Lloyd W. Klein, M.D., FSCAI, professor of Medicine at Rush Medical College and lead author of the statement.  "It is our responsibility as the physicians who perform interventions to actively participate in developing the tools to measure and report quality outcomes, and to ensure our patients always receive the highest quality care."  

The statement emphasizes the need for every PCI program to establish, and have backed by hospital resources, a Cardiac Catheterization Laboratory (cath lab) CQI Committee dedicated specifically to quality performance. The CQI Committee should be led by an experienced and respected interventional cardiologist. This committee's task is to measure and assess quality based on three basic principles:  (1) the structure of the system, (2) the processes involved for improving results and (3) the outcomes achieved.

In addition, the statement highlights multiple recommendations for evaluating PCI quality, including:

• The program must be focused on quality of care. A group of quality indicators should be established by the CQI committee based on suggested guidelines, accreditation bodies and local practice requirements that closely align with this focus.
• Quality measures should be compared to benchmarks in recent medical literature, and participation in regional or national databases is strongly encouraged.  
• A written protocol for PCI review should be developed for each CQI Committee. The process should be confidential to promote ongoing education.
• Ongoing peer-review assessment of each individual practitioner, including random case review, to assess their clinical proficiency and outcomes. Practitioners' outcomes should also be compared against national standards and benchmark databases. The primary goal should be to improve process within the spectrum of care.

"Interventional cardiologists have been at the forefront of quality improvement in medicine for decades as we recognize the process of improving quality for the best in patient care is always evolving and we must evolve with it," said Larry S. Dean, M.D., FSCAI, SCAI president and director of the UW Medicine Regional Heart Center and professor of Medicine and Surgery at the UW School of Medicine. "This paper is an important reference tool for interventional cardiologists to ensure quality in the cath lab."

The document published today is the first of a two-part statement developed by SCAI to address quality assessment and improvement in interventional cardiology. The second, which is scheduled for publication in the spring of 2011, will address public reporting, risk adjustment and the role of volume as an indicator for quality of care.

"As a medical society whose mission is focused on enhancing quality in interventional cardiovascular care, SCAI's role is to define the principles that should be employed within cardiac facilities as well as by regulatory agencies for defining quality, assessing quality and evaluating the structure, processes and outcomes of interventional care," said Dr. Klein. "This is what we set out to achieve with the two-part position statement."