Poll Results: Effectiveness of PCI-Related Quality Improvement Activities
Quick Takes
- Based on a small physician sample, physicians feel that small, non-threatening peer discussion is preferable to standardized registry outcome data for improving percutaneous coronary intervention (PCI) practice.
- Limits to the effectiveness of peer group discussions include practice competition and age/experience hierarchy.
In a recent American Heart Journal publication, Prabhu et al.1 reviewed the qualitative feelings of 20 interventional cardiologists regarding the value of outcome measures and other opportunities to improve performance through peer review and case conferences. Although the interview group was small, all 20 interventionalists performed at least 60 PCI procedures per year and were from a variety of regional and practice settings including private practice, academics, and Department of Veterans Affairs settings. In general, participants felt that standardized registry outcome data were often not effective in eliciting changes in practice alone but could be enhanced by individual discussions or by leadership or senior peers. Generally, case conferences with non-threatening peer comments were felt to be most helpful. Not surprisingly, practice competition as well as age/experience hierarchy were identified as potential barriers to peer interaction.
The poll addressed these issues. Although the responses were limited, nearly two thirds of respondents felt that registry data alone were often misleading based on practice setting and case mix, and just over 20% felt that registry data supported efforts to improve quality. No one felt that that registry data made an excellent comparative method to other practitioners. Most concerning is that approximately 15% of respondents felt that registry results were used by administration to control practice behavior.
In a second question directly asking what physicians felt was most helpful to assess PCI quality for their practice and provide opportunities for improvement, 15% identified registry reports, and 19% identified registry data coupled with catheterization laboratory leadership review. Most respondents (56%) felt that informal peer-to-peer discussions were best, and only 10% thought case reviews by practitioners outside their practice was useful.
Thus, these poll responses, although not unanimous, were consistent with the publication. It seems that there is value in the registry data if the results lead to positive discussions with catheterization laboratory leadership, but from an educational standpoint, most prefer peer discussions. Lastly, adverse use of registry data for corporate or leadership goals unrelated to practice is not useful. Therefore, continued focus on catheterization and morbidity and mortality conference teaching and catheterization leadership review with physicians based on registry data would appear to be optimal methods to optimize practice.
References
- Prabhu KM, Don C, Sayre GG, et al. Interventional cardiologists' perceptions of percutaneous coronary intervention quality measurement and feedback. Am Heart J 2021;Feb 7:[Epub ahead of print].
Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention
Keywords: Percutaneous Coronary Intervention, Leadership, Laboratories, Veterans, Peer Review, Private Practice, Morbidity, Outcome Assessment, Health Care, Diagnosis-Related Groups, Catheterization, Registries
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