Chapter 73. Quality Assurance and Quality Improvement in Interventional Cardiology
What are the 3 basic topic domains in a quality assurance/quality improvement (QA/QI) program?
A. Variability; mortality; adverse events
B. Meetings; publications; adverse events
C. Structure; processes; outcomes
D. Peer review; work flow; outcomes
A robust and comprehensive QA/QI program can generally be described as having 3 features or aspects: structure, which refers generally to the managerial organization of the QA/QI program; processes, which refers to the arrangement of medical care activities; and outcomes, which refers to the types of events that are examined. Within this broad tripartite layout, there are many subsidiary topics.
True or false? The major adverse event rates associated with general diagnostic cardiac catheterization procedures have declined over the past 2 decades.
One of the more gratifying findings that has been noted over 30 years of documentation of general diagnostic catheterization laboratory procedures is that adverse events like death, myocardial infarction, stroke, and emergency surgery have declined. In modern studies, these adverse events occur in fewer than 1% of cases and, generally, in 0.1%. The same has not been true overall for interventional procedures, although for some interventional procedures and some adverse outcomes, event rates have declined. The risk-treatment paradox for interventional procedures likely plays a role in this; as experience with a procedure grows, such that adverse event rates in “simple” cases decline, that procedure is then performed in more higher risk cases. This can lead to a non-zero “plateau” in overall adverse event rates with intervention.
Risk-adjustment models have been developed for all of the following adverse events with percutaneous coronary intervention (PCI) EXCEPT:
B. Acute kidney injury (AKI)
The National Cardiovascular Data Registries (NCDR) of the American College of Cardiology (ACC) have developed and validated a number of risk-adjustment models for certain procedures. This permits a more fair and balanced comparison of different institutions, which may have populations that vary in their procedural risks. For PCI, risk-adjustment models exist for death, bleeding, AKI, new need for dialysis, and 30-day readmission. As yet, there are no validated models for stroke with PCI.