South Florida Hospital News
Sunday September 22, 2019
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June 2008 - Volume 4 - Issue 12

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Spotlight On: Improving Cardiovascular Quality Measures

With recent emphasis placed on publicly-reported data in the healthcare environment, many hospitals are finding themselves in the quality spotlight. And, since this information is widely available as a result of transparency requirements, consumers have more and more data available to make informed decisions about their healthcare providers, especially when it comes to cardiovascular care.

The collection and accurate depiction of quality measures are vital to all industry stakeholders including hospitals, physicians, payors, and patients. In fact, as industry standards increasingly focus on quality via pay-for-performance and other mandatory and voluntary improvement initiatives, attention to outcomes data will be progressively more important for heart and vascular program success.

Corazon has worked with hospitals across the country on improving cardiovascular care through attention to data collection and benchmarking. Our industry research and experiences prove that demonstrating (and then marketing) cardiovascular quality is critical to a program’s viability—in terms of clinical, operational, and financial aspects of performance.

The Brief History

In early 1999, the Joint Commission solicited input from a wide variety of key stakeholders (e.g., clinical professionals, healthcare provider organizations, state hospital associations, healthcare consumers, performance measurement experts, and others) about potential focus areas for establishing ways to improve the safety and quality of care through a national, standardized performance measurement system. The result: The Core Measure Initiative, which allows the Joint Commission to review data trends and to work with hospitals as they use the information as benchmarks in order to improve patient care.

In May 2001, the Joint Commission announced the four initial core measurement areas for hospitals, two of which were focused on cardiac care: acute myocardial infarction (AMI) and heart failure (HF). Pneumonia (PN) and pregnancy and related conditions (PR) were the other two areas of focus.

Today, hospitals across the country are measured and compared by the Joint Commission against all other accredited institutions on their performance in these Core Measures.

Table 1:

AMI Core measures:

  • AMI-1: ASA at Arrival
  • AMI-2: ASA Prescribed at Discharge
  • AMI-3: ACEI or ARB for LVSD
  • AMI-4: Adult Smoking Cessation Advice/Counseling
  • AMI-5: Beta Blocker at Discharge
  • AMI-6: Beta Blocker at Arrival
  • AMI-7: Median Time to Fibrinolysis
  • AMI-7a: Fibronolytic therapy received within 30 minutes of hospital arrival
  • AMI-8: Median Time to Primary PCI
  • AMI-8a: Primary PCI received within 90 minutes of hospital arrival
  • AMI-9: Inpatient Mortality

    A Case Study for Quality Improvement

    By providing operational assessments, recommending changes, and implementing improvement strategies, Corazon provides expertise to guide hospitals with cardiovascular quality enhancement. Our experience has shown that in order to make significant and worthwhile improvements in care delivery, a fundamental process must occur, as outlined below.

    The impact of quality improvement can be reflected in the core measures for AMI (Table 1), specifically with emergent STEMI PCI care, as in this example.

    CORE Measure: Primary PCI received within 90 minutes of hospital arrival, also known as "Door to Balloon Time" (D2B). The importance of this measure is to provide fast, efficient care to the AMI patient in order to re-establish blood flow to the heart muscle as quickly as possible to avoid damage to the heart muscle.

    Step #1 - Develop a multidisciplinary cardiovascular team. Through frequent, consistent meetings, this team initiates all important communication to problem-solve and make changes in D2B process across all cardiovascular patient areas. This team needs to have a defined purpose, structure, and membership with involvement from both key administrators and physicians.

    Step #2 - Focus on troubleshooting frequently-challenging issues. Challenges to meet this measure are many, but can be resolved. Corazon has assisted hospitals with developing AMI tracking tools to determine each step of the process from first arrival of the patient through the inflation of the balloon in the Cath Lab. Adding EMS providers to the team on an ad hoc basis will provide additional insight on improving pre-hospital AMI care. Close evaluation of times and participants will enable the team to pinpoint areas of delay in patient care.

    Step #3 – Continually monitor core measure results. The cardiovascular team must closely evaluate the outcomes and share the results with staff during department meetings. This approach will enable the commitment and engagement of all participants, which will no doubt lead to results in improving cardiovascular care.

    Clearly, the focus placed on healthcare quality will only become more intense as facilities face continually-evolving cardiovascular trends and technology while working to assure quality at all levels of operations. Indeed, to prepare for the future, Corazon believes that hospitals must structure all aspects of their cardiovascular program with an eye toward excellence and quality as the ultimate goal.

  • Jayne Kulp is a Consultant at Corazon, a national leader in specialized consulting, management resources, and recruitment services for heart and vascular program development. For more information, call (412) 364-8200 or visit www.corazoninc.com.
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