SCAI Announces Position Statement on Public Reporting and Risk Adjustment for Quality Improvement Programs

May 5, 2011— The Society for Cardiovascular Angiography and Interventions (SCAI) announced its new position statement that calls for changes in the way that quality of percutaneous coronary intervention (PCI) care is measured and publicly reported. The statement was released during the SCAI 2011 scientific sessions in Baltimore, Maryland, and published online in Catheterization and Cardiovascular Interventions. It reviews the current standards for public reporting, risk adjustment, and the role of volume as an indicator for quality of care.

According to SCAI, for public reporting to facilitate quality improvement that yields better patient outcomes, clinical data must be accurately and consistently collected and outcomes must be risk-adjusted to account for the health of the patient.

“The interventional cardiology community supports the idea that improved patient outcomes is the primary goal in transforming health care, because it will improve our patients' health and reduce medical costs,” commented Lloyd W. Klein, MD, lead author of the statement. “But to do so, we need to ensure that we are collecting and sharing the best possible information. That means quality measures that are risk-adjusted and based on clinical data from the patient's medical chart.”

The statement recommends quality measures based on:

• Validated risk-adjustment models for mortality and major complications
• 30-day mortality, to follow patients after they leave the hospital
• Clinical data taken from patients' medical charts, not claims information intended for billing purposes, which is currently used by many quality programs
• Data collected in a nationally or regionally benchmarked database

In addition, the statement calls for a means of assessing clinical appropriateness of PCI procedures. Based on the recommendations outlined in this position statement, SCAI is advocating for:

• A mechanism for accurately defining and measuring 30-day mortality outcomes after a PCI procedure, using a risk-adjusted model that considers all major complications directly associated with PCI, not just all-cause mortality—a metric that does not always correlate to a patient's PCI procedure and therefore is not always an accurate measure of outcomes
• A means to benchmark programmatic results against national standards, as reported in databases, such as the National Cardiovascular Data Registry's CathPCI Registry, to identify best practices and standards of care to improve patient outcomes, as well as identify areas in need of correction and refinement, and make those adjustments in clinical practice

The statement is the second of a two-part report developed by SCAI to address quality assessment and improvement in interventional cardiology. As reported in Cardiac Interventions Today, the first part of the statement, which was released on March 1, 2011, addressed core standards and measures of assessing quality of interventional programs.