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Composite measure for the quality of care provided to patients undergoing percutaneous coronary interventions (PCI).

CBE ID
4580
Endorsement Status
1.0 New or Maintenance
Is Under Review
Yes
Next Maintenance Cycle
Fall 2024
1.6 Measure Description

This is a weighted composite measure comprised of six component measures: three all-cause risk standardized outcome measures on all-cause mortality, bleeding, acute kidney injury and three process measures focused on discharge on guideline directed medical therapy, referral to a cardiac rehabilitation program and PCI performed within ninety minutes of symptoms for patients with acute myocardial infarctions. The target population includes adults (age 18 and greater) undergoing percutaneous coronary interventions. The timeframe for reporting will be a rolling four quarters.  

Measure Specs
General Information
1.7 Measure Type
1.7a Other Measure Type
This is a weighted composite measure combining both outcome measures and process measures.
1.7 Composite Measure
Yes
1.3 Electronic Clinical Quality Measure (eCQM)
1.8 Level of Analysis
1.9 Care Setting
1.10 Measure Rationale

Measured entities should report this Quality-of-Care composite measure to provide a comprehensive assessment of the processes of care and in-hospital outcomes of patients following a percutaneous coronary intervention (PCI).  This composite measure will improve the quality of care associated with PCI by allowing both patients and hospitals to interpret quality by use of a performance score more easily than reporting the six component measures separately; and using the NCDR benchmark and reporting dashboard the measure will identify opportunities for improvement for poor performing hospitals.  Additionally, this single composite score can be used in the NCDR voluntary hospital public reporting program which monitors the quality of cardiovascular care using high quality data while providing actionable insights to hospitals. 

 

The most compelling benefit envisioned by use of this quality-of-care measure is reinforcing and supporting the right of an individual to know about the care that he or she is likely to receive. With the current national emphasis on the quality, accountability, and cost-effectiveness of health care, the various stakeholders and consumers of health care are eager to obtain information about health care facilities and providers.  Many public reports use data that are several years old, were not designed for clinical performance reporting, or are constructed using proprietary analytic methods that are difficult to reproduce or verify. This diverse reporting environment can confuse patients and purchasers, has the potential to take our focus away from the rights of the individual patient, and has led to divergent public rankings of the same facility in different reporting systems.

 

Recognizing the challenges to developing accurate and meaningful reporting, the ACC and its partnering organizations believe that a thoughtful, measured public reporting program, which uses clinical data with scientifically open methodology, subject to iterative improvement and oversight by professional organizations, has significant benefits while minimizing potential unintended consequences. Patients, payers, health care quality organizations, and governmental agencies all desire transparent and accurate reporting of the performance of cardiovascular programs. Clinicians and patients can benefit from access to this information as long as it is correct and provided in a fair and understandable format. The ACC believes it has a responsibility to move the profession toward acceptance of public reporting by using clinical data from the NCDR. Therefore, after careful study of the feasibility of public reporting using NCDR data, the ACC and its partnering organizations established the Public Reporting Advisory Group to oversee the implementation of the public reporting program and guide operational decisions necessary to achieve these goals. This composite measure that reports the quality of care for patients with PCI is a product of this Advisory Group work.

 

The potential population of patients and measured entities that can be informed by this measure is significant in size with significant associated healthcare costs.  An estimated 20.5 million people in the US ≥20 years of age have coronary heart disease (CHD). Approximately every 40 seconds, someone in the US will have a myocardial infarction. The estimated direct and indirect cost of heart disease in the US between 2019 to 2020 (average annual) was $252.2 billion. Myocardial infarction specifically cost at $14.3 billion and coronary heart disease at $8.7 billion were two of the ten most expensive conditions treated in US hospitals in 2017. (Martin et al.,) This composite measure reports the quality of care provided to a substantial portion of these patients.

 

Martin SS, Aday AW, Almarzooq ZI et al., 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation. 149; (8). doi: 10.1161/CIR.0000000000001209

1.20 Types of Data Sources
1.25 Data Source Details

American College of Cardiology’s (ACC) National Cardiovascular Data Registry (NCDR) CathPCI Registry.