American College of Cardiology and American Heart Association Methodology for the Selection and Creation of Performance Measures for Quantifying the Quality of Cardiovascular Care

Abstract

Abstract-The ability to quantify the quality of cardiovascular care critically depends on the translation of recommendations for high-quality care into the measurement of that care. As payers and regulatory agencies increasingly seek to quantify healthcare quality, the implications of the measurement process on practicing physicians are likely to grow. This statement describes the methodology by which the American College of Cardiology and the American Heart Association approach creating performance measures and devising techniques for quantifying those aspects of care that directly reflect the quality of cardiovascular care. Methods for defining target populations, identifying dimensions of care, synthesizing the literature, and operationalizing the process of selecting measures are proposed. It is hoped that new sets of measures will be created through the implementation of this approach, and consequently, through the use of such measurement sets in the context of quality improvement efforts, the quality of cardiovascular care will improve. M edicine is experiencing an unprecedented increased focus on quantifying and improving the quality of health care. Although healthcare quality is a multidimensional construct that, as articulated by the Institute of Medicine, 1 encompasses concepts of safety, equity, evidencebased medicine, timeliness of care, efficiency, and patientcenteredness, the foundation of efforts to improve care is predicated on measurement. Without the ability to quantify quality, the opportunity to identify practices that lead to higher-quality care, and the opportunity to learn how such care was delivered, quality cannot be improved. Therefore, developing a framework to measure components of the quality of health care is of paramount importance.The American College of Cardiology (ACC) and the American Heart Association (AHA) have developed a multifaceted strategy to facilitate the process of improving the quality of cardiovascular care. The initial phase of this effort was to create clinical practice guidelines that carefully review and synthesize the available evidence to better guide patient care. As articulated in a recent overview of the guidelines process, the creation of guidelines is but one component of the ACC's and the AHA's commitment to improving the

Quality indicators for the detection and management of chronic kidney disease in primary care in Canada derived from a modified Delphi panel approach

“…Each panel member completed conflict of interest and consent forms. Panelists completed 3 rounds of ratings of candidate measures using a Web-based tool and a criteria matrix based on an adaptation from previously established criteria 26,27 ( Figure 1). Panelists participated in a webinar after the first round, to allow for discussion and consensus building.…”

Canadian quality indicators for percutaneous coronary interventions

“…Quality indicators differ from practice guideline recommendations. Guidelines are written to suggest diagnostic and/or therapeutic interventions but interpretation is required by the clinician to apply these recommendations for each patient (10). In contrast, quality indicators are those processes in which the evidence is so strong that failure to perform such actions reduces the likelihood of optimal patient outcomes (10).…”

“…Une méthode de Delphes modifiée, en deux étapes, a été employée, avec une première sélection des indicateurs selon les cotes qui leur étaient attribuées, suivie d'une rencontre du comité national, puis de discussions en vue de l'atteinte de consensus. Quality indicators or performance measures are defined as processes in which the evidence is so strong that failure to perform such actions reduces the likelihood of optimal patient outcomes (10). Quantifying adherence to quality indicators can therefore serve as a direct measure of the quality of care and provide a measurable target for quality improvement (10).…”

“…Quality indicators or performance measures are defined as processes in which the evidence is so strong that failure to perform such actions reduces the likelihood of optimal patient outcomes (10). Quantifying adherence to quality indicators can therefore serve as a direct measure of the quality of care and provide a measurable target for quality improvement (10). Although efforts have been instituted to develop quality indicators for myocardial infarction, heart failure and CABG, there are currently no widely accepted standards on what constitutes high quality of care for PCI (11)(12)(13).…”

“…Measures that received a rating of 4 or above for structural and process indicators and an agreement of more than twothirds for outcomes indicators for inclusion in the final set of indicators were included. The method of selecting performance measures in the present study was similar to the process supported by other professional societies (10,19). A follow-up conference call was held to refine the definitions of each quality indicator and to reconcile potential differences.…”