PCI Performance Measures Include Patient Selection, Appropriateness

Measures examine care before, during and after procedure

Contact: Rachel Cagan, rcagan@acc.org, 202-375-6395

WASHINGTON (Dec. 19, 2013)— Careful documentation of patient selection and procedure appropriateness are critical—yet underutilized—steps in ensuring high-quality clinical care for percutaneous coronary intervention (PCI), according to performance measures released today by the American College of Cardiology, the American Heart Association, the Society for Cardiovascular Angiography and Interventions, the AMA-Convened Physician Consortium for Performance Improvement, and the National Committee for Quality Assurance.
Designed to benchmark and improve the quality of PCI, the set of performance measures includes 11 measures that address both ambulatory and inpatient settings, with two measures that address documentation and appropriateness.  The document focuses primarily on elective PCI.  

The new set of measures breaks important ground for performance measurement examining care before, during and after the procedure. It is the first set of cardiovascular performance measures to directly address procedure appropriateness.  In addition, the measures incorporate other indicators of quality, such as procedural volume and whether the institution benchmarks care by participating in regional or national registries.  

The 11 measures are: 
1. Comprehensive documentation of the reasons for PCI
2. An appropriate reason for elective PCI  (benefits outweigh the risks)  
3. An evaluation of the individual’s ability to receive dual antiplatelet therapy (conducted before the procedure)
4. The use of embolic protection devices in the treatment of saphenous vein bypass graft disease
5. An assessment of renal function before the procedure (including glomerular filtration rate) and the documentation of contrast used during the procedure
6. Documentation of the radiation dose used during the procedure
7. The prescription of optimal medical therapy at discharge (aspirin, PY12 inhibitors and statins)   
8. A referral to an outpatient cardiac rehabilitation program (to reduce the risk of recurrent events)   
9. Participation in a regional or national PCI registry  
10. The average annual volume of PCIs performed by the physician over the last 2 calendars years
11. The average annual volume of PCIs performed by the hospital over the last calendar year

Measures 1, 3, 5, 7, 8, 9 and 11 performance measures, and 2, 4, 6, and 10 are quality metrics. Quality metrics may not meet all specifications of formal performance measures or may be associated with unintended consequences of public reporting

According to the writing committee, the measures may “serve as vehicles to accelerate appropriate translation of scientific evidence into clinical practice.” The committee goal was to create measures that capture many important aspects of quality while minimizing the reporting burden. 

“Hospitals and health systems are increasingly facing a burden with measurement across multiple conditions and services,” stated Carl Tommaso, MD, an interventional cardiologist at NorthShore University Health-System and writing committee co-chair. “We wanted to focus on those aspects of PCI care that we thought would give us the greatest yield in terms of improving patient care.” 

Brahmajee Nallamothu, MD, associate professor of cardiovascular medicine in the Department of Internal Medicine at the University of Michigan and writing committee co-chair, said this document is the first step in the evolving process of performance measurement.  

“Through these measures, we have moved beyond simple measurement of a few treatments to incorporating key concepts like appropriateness,” Nallamothu said. “There is still much more work to be done, however, and an important part of this process was to identify important areas for future investigation.” 

The committee identified four areas of research that will generate better performance measures in the future:  1) measuring the filling of prescriptions (not just the prescription of drugs) and optimal dosing, 2) better utilizing current data systems to track PCI quality, 3) building accountability by all practitioners involved into quality metrics, and 4) utilizing patient surveys to track performance. 

The 2013 Performance Measures for Adults Undergoing Percutaneous Coronary Intervention will be published online today at today on the ACC website (www.cardiosoure.org) and the AHA (www.americanheart.org) and in a future print issues Journal of the American College of Cardiology (JACC) and Circulation: Journal of the American Heart Association.

About the American College of Cardiology
The mission of the American College of Cardiology is to transform cardiovascular care and improve heart health. The College is a 43,000-member medical society comprised of physicians, surgeons, nurses, physician assistants, pharmacists and practice managers. The College is a leader in the formulation of health policy, standards and guidelines. The ACC provides professional education, operates national registries to measure and improve quality of care, disseminates cardiovascular research, and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more information, visit www.cardiosource.org.

About the American Heart Association
The American Heart Association is devoted to saving people from heart disease and stroke – America’s No. 1 and No. 4 killers. We team with millions of volunteers to fund innovative research, fight for stronger public health policies, and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit heart.org or call any of our offices around the country.  Follow us on Facebook and Twitter.

About the Society for Cardiovascular Angiography and Interventions 
The Society for Cardiovascular Angiography and Interventions is a 4,000-member professional organization representing invasive and interventional cardiologists in approximately 70 nations. SCAI's mission is to promote excellence in invasive/interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI's public education program, Seconds Count, offers comprehensive information about cardiovascular disease. For more information about SCAI and Seconds Count, visit http://www.SCAI.org/or www.SecondsCount.org. Follow @SCAI and @SCAINews on Twitter for the latest heart health news.

About the AMA-convened Physician Consortium for Performance Improvement
The AMA-convened PCPI® is a national, physician-led program whose mission is to align patient-centered care, performance measurement and quality improvement. Made up of 190 member organizations, the PCPI® is dedicated to enhancing quality and patient safety. The consortium is a leader in developing, testing and implementing evidence-based performance measures for use at the point of care. To date, over 300 individual measures across 47 clinical areas have been developed. Visit www.physicianconsortium.org for more information.

About the National Committee for Quality Assurance
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.


< Back to Listings