New performance measures designed to benchmark and improve the quality of percutaneous coronary intervention (PCI) procedures were released Dec. 18 by the ACC, the American Heart Association, the Society for Cardiovascular Angiography and Interventions, the American Medical Association -Convened Physician Consortium for Performance Improvement, and the National Committee for Quality Assurance.

The document represents the first set of performance measures dedicated to PCI and focuses primarily on elective PCI. Further, it is the first set of cardiovascular performance measures to directly address procedure appropriateness.

The performance measures address pre-procedural, procedural and post-procedural quality to emphasize the care of the patient before, during and after a PCI. They also address both ambulatory and inpatient settings, with two measures that address documentation and appropriateness.

The performance measures include:

1. Comprehensive documentation of indications for PCI
2. An appropriate indication for elective PCI
3. Assessment of candidacy for dual antiplatelet therapy (conductedprior to the procedure)
4. The use of embolic protection devices in the treatment of saphenous vein bypass graft disease
5. An assessment of renal function before the procedure (including glomerular filtration rate) and the documentation of contrast used during the procedure
6. Documentation of the radiation dose used during the procedure
7. The prescription of optimal medical therapy at discharge (aspirin, P2Y12 inhibitors and statins)
8. A referral to an outpatient cardiac rehabilitation program (to reduce the risk of recurrent events)
9. Participation in a regional or national PCI registry
10. The average annual volume of PCIs performed by the physician over the last two calendars years
11. The average annual volume of PCIs performed by the hospital over the last calendar year

According to Brahmajee Nallamothu, MD, MPH, FACC, co-chair of the writing committee, the performance measures try to compliment other national initiatives led by the Centers for Medicare and Medicaid Services and the ACC, and emphasize the importance of comprehensive documentation and an appropriate indication for PCI. Further, they include both accountability measures – which are acceptable for public reporting and for facilitating comparisons across providers – and quality improvement measures – which should be used to drive internal quality improvements.

"Through these measures, we have moved beyond simple measurement of a few treatments to incorporating key concepts like appropriateness," said Nallamothu. "There is still much more work to be done, however, and an important part of this process was to identify important areas for future investigation."

The authors note that moving forward, there are four areas of research needed to generate better performance measures in the future: measuring the filling of prescriptions (not just the prescription of drugs) and optimal dosing; better utilizing current data systems to track PCI quality; building accountability by all practitioners involved into quality metrics; and utilizing patient surveys to track performance.

Keywords: Referral and Consultation, Centers for Medicare and Medicaid Services, U.S., Inpatients, Percutaneous Coronary Intervention, Quality Improvement, Registries, Embolic Protection Devices, Outpatients, Saphenous Vein, Glomerular Filtration Rate