Skip to Main Content

++
++

Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.

++

—Willa A. Foster

++

In the United States, health care expenditures account for nearly 16% of the gross domestic product and are continuing to rise.1 Although many technologic and therapeutic advances are worthy of praise, the quality of care delivered is nowhere near the level expected or desired from our investment.2-4 Cardiovascular medicine, in particular, has benefitted enormously from the investment in scientific discovery and clinical research5; yet the timely, systematic translation of new knowledge into clinical practice remains a challenge. To advance evidence-based practice and to reduce the variability in the quality of cardiovascular care, three key tools—clinical guidelines, performance measures, and appropriate use criteria—have been developed and promoted for quality assessment and improvement. This chapter provides an overview of these tools in the context of accepted frameworks to maximize quality and safety, after briefly reviewing the need for continual assessment and improvement of the quality of health care in the United States.

++

The United States invests an estimated $2.4 trillion dollars in health care, with a projected annual growth rate of 6.2% over the next 10 years.1 For a country that spends more money than any other nation in the world,6 however, the United States ranks poorly on most standardized health indices7 and quality metrics.4,8 In the United States, cardiovascular disease (CVD) remains the leading cause of death and disability, with an estimated annual total cost of $475.3 billion.9 Such a magnitude of disease burden necessitates and demands careful scrutiny of the quality of care being delivered.

++

Progress in Cardiovascular Care

++

Cardiovascular medicine in the United States has benefitted enormously from the investment in scientific discovery and clinical research, leading to many advances in the knowledge and treatment of the disease process. Importantly, the last 3 decades have witnessed substantial improvements in age-adjusted mortality rates due to CVD, coronary artery disease (CAD), and stroke (Fig. 3–1),5 a likely reflection of the successful adoption of primary and secondary prevention, coupled with improved treatments for acute cardiac conditions. Data from large population studies support these findings with marked reductions observed in the age- and race-adjusted rates of sudden death due to CAD,10 as well as in the incidence, case fatality rates, and mortality associated with CVD between 1971-1982 and 1982-1992.11a-11c

++
FIGURE 3–1
Graphic Jump LocationGraphic Jump LocationGraphic Jump Location

Percent decline in age-adjusted mortality rates for (A) cardiovascular disease (reference year: 1979), (B) coronary artery disease (reference year: 1970), ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessCardiology Full Site: One-Year Subscription

Connect to the full suite of AccessCardiology content and resources including textbooks such as Hurst's the Heart and Cardiology Clinical Questions, a unique library of multimedia, including heart imaging, an integrated drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessCardiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.