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Canadian Journal of Cardiology

Quality of Care for Percutaneous Coronary Intervention: Development of Canadian Cardiovascular Society Quality Indicators

      Abstract

      Currently there are more than 40 centres in Canada that perform more than 65,000 percutaneous coronary interventions (PCIs) in a year. Considering the high volume of procedures and number of operators, the potential for variation in processes of care is high, and might lead to variation in the quality of care. As part of its quality initiative, the Canadian Cardiovascular Society convened a working group to develop a set of PCI Quality Indicators (QIs) that would be relevant, scientifically acceptable, and feasible to measure and report. The working group was comprised of clinical experts from across Canada and members of provincial and federal organizations involved in promoting the quality of health care. Using the Canadian Cardiovascular Society “Best Practices for Developing Cardiovascular Quality Indicators” methodology, a total of 23 QIs were proposed. Subsequent ranking and discussion led to the selection of 8 QIs. The selection and ranking of QIs were on the basis of clinical importance and relevance, scientific acceptability, and feasibility of their operationalization at a national level. The data definitions and technical notes of the QIs were refined after feasibility testing and Web consultation. Feasibility testing indicated that standardization and enhancements of knowledge infrastructure are essential to provide the comprehensive patient data necessary to evaluate the quality of PCI across Canada.

      Résumé

      Au Canada, plus de 65 000 interventions coronariennes percutanées (ICP) sont pratiquées chaque année dans plus de 40 centres hospitaliers. Étant donné cette multitude d’interventions et le nombre de chirurgiens, la possibilité d’écarts dans les modalités des soins prodigués est considérable, ce qui risque d’entraîner des écarts dans la qualité des soins offerts. Dans le cadre de son initiative sur la qualité des soins, la Société canadienne de cardiologie (SCC) a créé un groupe de travail chargé d’établir une série d’indicateurs de la qualité (IQ) des ICP qui seraient à la fois pertinents, acceptables du point de vue scientifique, mesurables et publiables. Ce groupe de travail était constitué de cliniciens experts de partout au Canada et de membres d’organismes fédéraux et provinciaux travaillant à la promotion de la qualité des soins de santé. Utilisant la méthodologie ciblant les « meilleures pratiques pour l’établissement des indicateurs de la qualité des soins cardiovasculaires » de la SCC, le groupe a initialement proposé 23 IQ, qui ont ensuite fait l’objet d’un classement et de discussions qui ont conduit à la sélection de 8 IQ. Cette sélection était basée sur les critères suivants : importance et pertinence cliniques, acceptabilité sur le plan scientifique et applicabilité à l’échelle nationale. Les notes techniques et les définitions de données des IQ ont été améliorées après les essais de faisabilité et un processus de consultation sur le Web. Les essais de faisabilité ont indiqué que l’amélioration et la normalisation de l’infrastructure des connaissances étaient essentielles pour dresser un portrait complet des patients et ainsi évaluer la qualité des ICP effectuées au pays.
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      References

        • Harold J.G.
        • Bass T.A.
        • Bashore T.M.
        • et al.
        ACCF/AHA/SCAI 2013 update of the clinical competence statement on coronary artery interventional procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on clinical competence and training (Writing committee to revise the 2007 clinical competence statement on cardiac interventional procedures).
        Circulation. 2013; 128: 436-472
        • Ko D.T.
        • Wijeysundera H.C.
        • Zhu X.
        • et al.
        Canadian quality indicators for percutaneous coronary interventions.
        Can J Cardiol. 2008; 24: 899-903
        • Krumholz H.M.
        • Brindis R.G.
        • Brush J.E.
        • et al.
        Standards for statistical models used for public reporting of health outcomes: an American Heart Association scientific statement from the Quality of Care and Outcomes Research Interdisciplinary Writing Group: cosponsored by the Council on Epidemiology and Prevention and the Stroke Council: endorsed by the American College of Cardiology Foundation.
        Circulation. 2006; 113: 456-462
        • American College of Emergency Physicians
        • Society for Cardiovascular Angiography and Interventions
        • O'Gara
        • et al.
        2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2013; 61: e78-e140
        • Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC)
        • Steg P.G.
        • James S.K.
        • et al.
        ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.
        Eur Heart J. 2012; 33: 2569-2619