SCAI Publishes Statement on Standards for Quality Assessment and Improvement

March 1, 2011—The Society for Cardiovascular Angiography and Interventions (SCAI) announced the publication of recommendations for assessing and improving quality in percutaneous coronary intervention (PCI) programs at cardiac facilities. The statement was drafted by Lloyd W. Klein, MD, et al and published online ahead of print in Catheterization and Cardiovascular Interventions.

The document offers guidance regarding core measures for quality and assessment in PCI programs and is a tool for interventional cardiologists to use in their ongoing focus on improving patient care. The document is the first of a two-part statement developed by SCAI to address quality assessment and improvement in interventional cardiology. The second part of the statement is scheduled for publication in the spring of 2011 and will address public reporting, risk adjustment, and the role of volume as an indicator for quality of care.

According to SCAI, in an era of health reform, where institutions may soon adopt a “pay-for-performance” model, defined measures of quality have become an increasingly relevant need for PCI programs. In 2005, SCAI in partnership with the American Heart Association and the American College of Cardiology (ACC) authored guidelines requiring all PCI facilities to evaluate performance through a continuous quality improvement (CQI) process. SCAI and ACC have also established a catheterization laboratory accreditation program, Accreditation for Cardiovascular Excellence (ACE), designed to help standardize and track quality measures in PCI programs. ACE requires participating programs to establish a CQI process. The current statement better defines the established set of core quality measures and assessments for institutions with CQI programs, advised SCAI.

“This statement demonstrates the interventional cardiology community's dedication to upholding quality standards and continually improving patient care, including what the specific components of a quality improvement program should be,” commented Dr. Klein. “It is our responsibility as the physicians who perform interventions to actively participate in developing the tools to measure and report quality outcomes, and to ensure our patients always receive the highest quality care.”

The statement emphasizes the need for every PCI program to establish a cardiac catheterization laboratory CQI committee that is dedicated specifically to quality performance, is lead by an experienced and respected interventional cardiologist, and is supported by hospital resources. The committee's task is to measure and assess quality based on three basic principles: the structure of the system; the processes involved for improving results; and the outcomes achieved. The statement also highlights multiple recommendations for evaluating PCI quality, including:

• The program must be focused on quality of care. The CQI committee should establish a group of quality indicators based on suggested guidelines, accreditation bodies, and local practice requirements that closely align with this focus.
• Quality measures should be compared to benchmarks in recent medical literature, and participation in regional or national databases is strongly encouraged.
• A written protocol for PCI review should be developed for each CQI committee. The process should be confidential to promote ongoing education.
• Ongoing peer-review, including random case review, to assess each practitioner's clinical proficiency and outcomes. Practitioners' outcomes should also be compared against national standards and benchmark databases. The primary goal should be to improve process within the spectrum of care.