Introduction
Definition of quality indicators
Structure indicators | Process indicators | Outcome indicators | |
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Example
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PCI volume a year
|
Medical prescription according to guidelines
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Morbidity and mortality
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Availability of cathlab
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Door-to-balloon-times
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Functional health status
| |
Education level of the nurses
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Patient satisfaction
| ||
Costs
| |||
Advantages
| Appropriate | Reflect care that patients actually receive | The ‘bottom-line’ of cardiology |
If associated with outcome, inexpensive proxies of cardiological outcomes | Actionable from provider perspective | Outcomes measurement alone may improve outcomes | |
Clear link to quality improvement activities | |||
Disadvantages
| Most variables not actionable from provider perspective | Little information about which processes are important for specific procedures | Numbers too small to measure with adequate procedure-specific outcomes for most hospitals and procedures |
Imperfect proxies for outcomes reflect average results for large groups of providers, not individuals | Outcome measures that are not procedure-specific less useful for purposes of quality improvement |
Registration in cardiology in the Netherlands
National quality measurement
National quality registries in cardiology
International registries
Country | National registry | Founded | Remarks |
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Belgium | Belgian STEMI project (44, 45)
BIWAC, Belgian Interdisciplinary Working Group on Acute Cardiology
| 2007 | Covering: obligatory for all Belgian hospitals; 50-60% STEMI patients a year are registrated Details: 3000 patients a year Variables: 25-30 Funding: Public, not linked with reimbursement |
PCI registry (46)
BWGIC, Belgian Working Group Interventional Cardiology
| Covering: all PCI hospitals Funding: Public, linked with a minimal reimbursement on PCI material | ||
England/Wales | MINAP (28, 29)
Myocardial Ischaemia National Audit Project
| 2000 | Covering: all 236 acute hospitals in England and Wales for ACS patients (STEMI and NSTEMI) Details: 735 000 patients (2010) Variables: 123 Funding: Public, by participating hospitals |
France | FAST-MI (47, 48)
French registry of Acute ST-segment elevation or non-ST-segment elevation Myocardial Infarction
| 2005 | Covering: 223 centres (60%). Data collection every five years Details: 1714 STEMI patients Variables: 385 in 2010 Funding: Public and private, by French Society of Cardiology and several pharmaceutical companies |
Sweden | SWEDEHEART (28, 49)
A collaboration (since 2008) of RISK-HIA, SEPHIA, SCAAR, Swedish Heart Surgery Registry and Percutaneous Valve Registry
| 2008 | Covering: all 74 hospitals in Sweden for ACS patients undergoing CAG/PCI, percutaneous valve replacement or heart surgery. Details: 80.000 new patients each year (3 million in total) Variables: 106 variables ACS, 75 variables regarding secondary prevention, 150 variables for patients undergoing coronary angiography/angioplasty, 100 variables heart surgery. Funding: Public, by the Swedish Association of Local Authorities and Regions. Not linked with reimbursement |
Switzerland | AMIS Plus (50)
Acute Myocardial Infarction in Switzerland
| 1997 | Covering: 106 hospitals (> 60%) in Switzerland with STEMI/NSTEMI, voluntary participation Details: 33.040 patients (2010) Variables: 230 variables Funding: Private, sponsored by several industries |
United States of America | NCDR®CathPCI (27, 28) National Cardiovascular Data Registry | 1998 | Covering: 1577 hospitals (90% of PCI-centres) in the United States Details: 12 million patients. Variables: 250 variables. Funding: reimbursement by insurance companies for participating hospitals |