New SCAI position statement calls for changes in percutaneous coronary intervention care

Society for Cardiovascular Angiography and Interventions (SCAI)May 6 2011

A new position statement released today by the Society for Cardiovascular Angiography and Interventions (SCAI) calls for changes in the way quality of percutaneous coronary intervention (PCI, also known as angioplasty) care is measured and publically reported. The position statement, released during the SCAI 2011 Scientific Sessions and published online in Catheterization and Cardiovascular Interventions (CCI), reviews current standards for public reporting, risk adjustment and the role of volume as an indicator for quality of care.

Increasingly, policymakers and regulators are evaluating publically reported quality health care measures in an effort to curb costs and help improve patient care.  However, many of today's standards are inadequate for judging the true quality of care delivered in a hospital or by an individual physician. For public reporting to facilitate quality improvement that yields better patient outcomes, clinical data must be accurately and consistently collected and outcomes must be risk-adjusted to account for the health of the patient.

"The interventional cardiology community supports the idea that improved patient outcomes is the primary goal in transforming health care, because it will improve our patients' health and reduce medical costs," said Lloyd W. Klein, M.D., FSCAI, professor of Medicine at Rush Medical College and lead author of the statement. "But to do so, we need to ensure we are collecting and sharing the best possible information. That means quality measures that are risk-adjusted and based on clinical data from the patient's medical chart."

The statement recommends quality measures based on:

• Validated risk-adjustment models for mortality and major complications
• 30-day mortality, to follow patients after they leave the hospital
• Clinical data taken from patients' medical charts, not claims information intended for billing purposes currently used by many quality programs
• Data collected in a nationally or regionally benchmarked database

In addition, the statement calls for a means of assessing clinical appropriateness of PCI procedures.  Based on the recommendations outlined in this position statement, SCAI is advocating for:

• A mechanism for accurately defining and measuring 30-day mortality outcomes post PCI procedure, using a risk-adjusted model that considers all major complications directly associated with PCI, not just all-cause mortality – a metric that does not always correlate to a patient's PCI procedure and therefore is not always an accurate measure of outcomes.
• A means to benchmark programmatic results against national standards, as reported in to databases such as the NCDR CathPCI Registry, to identify best practices and standards of care to improve patient outcomes, as well as identify areas in need of correction and refinement and make those adjustments in clinical practice.

"We need to understand the patient's outcome following a procedure, and we also need to understand how sick the patient was prior to the procedure and whether it was appropriate given the patient's condition," said Dr. Klein. "As quality is increasingly reported, we must ensure we do so in a way that is appropriately measuring true outcomes – highlighting where care was effective and also where it was ineffective – and using that information to improve care for all our patients."