Abstract
Quality indicators (QIs) are increasingly being used to measure and improve the quality
of cardiac care. We conducted an international environmental scan to identify and
critically appraise published QI development initiatives addressing cardiovascular
disease (CVD). A review of the peer-reviewed and grey English-language literature
was conducted to identify published CVD QI development initiatives. The quality of
identified studies was assessed using a modified version of the Appraisal of Guidelines
for Research and Evaluation (AGREE) II QI tool—an instrument originally developed
for the assessment of the quality of clinical practice guidelines. An initial literature
search identified 2314 potentially relevant abstracts of peer-reviewed articles. After
a review of the abstracts, 120 full text articles were retrieved and reviewed. Of
these, 20 articles and 1 peer-reviewed monograph were selected for critical appraisal
(n = 21). Most of the initiatives were conducted in North America (76%) and were published
after 2005 (62%). The majority (5 of 6) of the AGREE II QI domain scores were skewed
toward higher values, including the median score for the ‘overall quality’ rating
(83.3%). Of the CVD categories addressed within the 21 initiatives, heart failure
was the most common (n = 10 QI indicator sets), followed by acute coronary syndromes
(n = 8). Considerable variation was observed in the methods utilized and the degree
of scientific rigour applied in the published international CVD QI development initiatives.
Adoption of standardized methods could help improve the quality of QI development
initiatives.
Résumé
Les indicateurs de la qualité (IQ) sont de plus en plus utilisés pour mesurer et améliorer
la qualité des soins cardiaques. Nous avons mené une analyse environnementale internationale
pour définir et évaluer de manière critique les publications sur les initiatives de
développement des IQ portant sur la maladie cardiovasculaire (MCV). Une revue de la
littérature grise anglophone examinée par des pairs a été menée pour définir les publications
sur les initiatives de développement des IQ portant sur les MCV. La qualité de ces
études a été évaluée en utilisant une version modifiée de l'outil d'IQ Appraisal of Guidelines for Research and Evaluation (AGREE) II – un instrument conçu au départ pour l'évaluation de la qualité des lignes directrices
de la pratique clinique. Une recherche initiale de littérature a déterminé 2 314 résumés
potentiellement pertinents d'articles examinés par des pairs. Après une revue des
résumés, 120 articles en texte intégral ont été extraits et revus. Parmi ceux-ci,
20 articles et 1 monographie examinée par des pairs ont été sélectionnés pour une
évaluation critique (n = 21). La plupart des initiatives ont été menées en Amérique
du Nord (76 %) et ont été publiées après 2005 (62 %). La majorité (5 de 6) des scores
du domaine des IQ de AGREE II ont été faussées par des valeurs plus élevées, incluant
le score médian pour la notation de la « qualité globale » (83,3 %). Des catégories
de MCV dont il est question dans les 21 initiatives, l'insuffisance cardiaque a été
la plus fréquente (ensembles d'indicateurs IQ, n = 10), suivie par les syndromes coronariens
aigus (n = 8). Une variation importante a été observée dans les méthodes utilisées
et le degré de rigueur scientifique appliquée aux publications des initiatives internationales
de développement des IQ portant sur la MCV. L'adoption de méthodes standardisées aiderait
à améliorer la qualité des initiatives de développement des IQ.
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References
- Adherence to heart failure quality-of-care indicators in US hospitals: analysis of the ADHERE Registry.Arch Intern Med. 2005; 165: 1469-1477
- Management of acute coronary syndromes.Eur Heart J. 2002; 23: 1177-1189
- Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction: findings from the Global Registry of Acute Coronary Events (GRACE).Lancet. 2002; 359: 373-377
- Research methods used in developing and applying quality indicators in primary care.Qual Saf Health Care. 2002; 11: 358-364
- Prioritizing quality indicator development across the healthcare system: identifying what to measure.Intern Med J. 2009; 39: 648-654
- Developing evidence-based clinical indicators: a state of the art methods primer.Int J Qual Health Care. 2003; 15: i5-i11
- Kerr E.A. Asch S.M. Hamilton E.G. McGlynn E.A. Quality of Care for Cardiopulmonary Conditions: A Review of the Literature and Quality Indicators RAND monograph report: MR-1282-AHRQ. 2000
- The Diabetes Quality Improvement Project: moving science into health policy to gain an edge on the diabetes epidemic.Diabetes Care. 2001; 24: 1815-1820
- American College of Cardiology and American Heart Association methodology for the selection and creation of performance measures for quantifying the quality of cardiovascular care.J Am Coll Cardiol. 2005; 45: 1147-1156
- Measuring and improving quality of care: a report from the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke.Circulation. 2000; 101: 1483-1493
- Performance measurement in healthcare: part II - state of the science findings by stage of the performance measurement process.Healthcare Policy. 2006; 2: 56-78
- Measuring the quality of hospital care: an inventory of indicators.Intern Med J. 2009; 39: 352-360
- Measuring and reporting on quality in health care: a framework and road map for improving care.J Surg Oncol. 2009; 99: 462-466
- Quality indicators, performance measures, and accountability: the right thing, at the right time, for the right reason.J Thorac Cardiovasc Surg. 2006; 131: 4-8
- AGREE II: Advancing guideline development, reporting and evaluation in health care.CMAJ. 2010; 182: E839-E842
- Development of the AGREE II, part 1: performance, usefulness and areas for improvement.CMAJ. 2010; 182: 1045-1052
- Development of the AGREE II, part 2: assessment of validity of items and tools to support application.CMAJ. 2010; 182: E472-E478
- Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project.Qual Saf Health Care. 2003; 12: 18-23
- Evaluating the quality of medical care.Milbank Q. 2005; 83: 691-729
- ACC/AHA clinical performance measures for adults with chronic heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Heart Failure Clinical Performance Measures) endorsed by the Heart Failure Society of America.J Am Coll Cardiol. 2005; 46: 1144-1178
- Measuring performance to drive improvement: development of a clinical indicator set for general medicine.Intern Med J. 2009; 39: 361-369
- Quality indicators for cardiovascular primary care.Can J Cardiol. 2007; 23: 383-388
- Quality indicators for the prevention and management of cardiovascular disease in primary care in nine European countries.Eur J Cardiovasc Prev Rehabil. 2008; 15: 509-515
- ACC/AHA/Physician Consortium 2008 Clinical Performance Measures for Adults with Nonvalvular Atrial Fibrillation or Atrial Flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation) developed in Collaboration with the Heart Rhythm Society.J Am Coll Cardiol. 2008; 51: 865-884
- The identification and development of Canadian coronary artery bypass graft surgery quality indicators.J Thorac Cardiovasc Surg. 2005; 130: 1257
- Using clinical indicators in a quality improvement programme targeting cardiac care.Int J Qual Health Care. 2004; 16: i11-i25
- Selecting indicators for the quality of cardiac care at the health system level in Organization for Economic Co-operation and Development countries.Int J Qual Health Care. 2006; 18: 39-44
- Canadian quality indicators for percutaneous coronary interventions.Can J Cardiol. 2008; 24: 899-903
- ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American Academy of Family Physicians and American College of Emergency Physicians endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, Society for Cardiovascular Angiography and Interventions, and Society of Hospital Medicine.J Am Coll Cardiol. 2008; 52: 2046-2099
- AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons.J Am Coll Cardiol. 2007; 50: 1400-1433
- CCORT/CCS quality indicators for congestive heart failure care.Can J Cardiol. 2003; 19: 357-364
- The development of indicators to measure the quality of clinical care in emergency departments following a modified-delphi approach.Acad Emerg Med. 2002; 9: 1131-1139
- The National Heart Failure Project: a health care financing administration initiative to improve the care of Medicare beneficiaries with heart failure.Congest Heart Fail. 2000; 6: 337-339
- ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 performance measures for adults with peripheral artery disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures, the American College of Radiology, the Society for Cardiac Angiography and Interventions, the Society for Interventional Radiology, the Society for Vascular Medicine, the Society for Vascular Nursing, and the Society for Vascular Surgery (Writing Committee to Develop Clinical Performance Measures for Peripheral Artery Disease).J Am Coll Cardiol. 2010; 56: 2147-2181
- ACCF/AHA 2009 performance measures for primary prevention of cardiovascular disease in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for Primary Prevention of Cardiovascular Disease) developed in collaboration with the American Academy of Family Physicians; American Association of Cardiovascular and Pulmonary Rehabilitation; and Preventive Cardiovascular Nurses Association: endorsed by the American College of Preventive Medicine, American College of Sports Medicine, and Society for Women's Health Research.J Am Coll Cardiol. 2009; 54: 1364-1405
- Quality indicators for the management of medical conditions in nursing home residents.J Am Med Dir Assoc. 2005; 6: S36-S48
- Clinical performance indicators for percutaneous coronary intervention.Crit Pathw Cardiol. 2008; 7: 126-132
- Indicators of quality of care for patients with acute myocardial infarction.CMAJ. 2008; 179: 909-915
- Introduction to the assessing care of vulnerable elders-3 quality indicator measurement set.J Am Geriatr Soc. 2007; 55: S247-S252
- AACVPR/ACCF/AHA 2010 Update: Performance Measures on Cardiac Rehabilitation for Referral to Cardiac Rehabilitation/Secondary Prevention Services endorsed by the American College of Chest Physicians, the American College of Sports Medicine, the American Physical Therapy Association, the Canadian Association of Cardiac Rehabilitation, the Clinical Exercise Physiology Association, the European Association for Cardiovascular Prevention and Rehabilitation, the Inter-American Heart Foundation, the National Association of Clinical Nurse Specialists, the Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons.J Am Coll Cardiol. 2010; 56: 1159-1167
- Quality indicators for the care of stroke and atrial fibrillation in vulnerable elders.J Am Geriatr Soc. 2007; 55: S431-S437
- Quality indicators for the care of heart failure in vulnerable elders.J Am Geriatr Soc. 2007; 55: S340-S346
- Quality indicators for the care of hypertension in vulnerable elders.J Am Geriatr Soc. 2007; 55: S359-S365
- Quality indicators for the care of ischemic heart disease in vulnerable elders.J Am Geriatr Soc. 2007; 55: S366-S372
- ACCF/AHA new insights into the methodology of performance measurement.J Am Coll Cardiol. 2010; 56: 1767-1782
- Evaluating the quality of clinical and health indicators.(Accessed October 5, 2010)
Article info
Publication history
Published online: December 12, 2011
Accepted:
September 19,
2011
Received:
July 11,
2011
Footnotes
See page 116 for disclosure information.
Identification
Copyright
© 2012 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
