ACCA: Vascular quality management programs present consensus challenges

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ORLANDO, Fla.—There is no single national standard for vascular quality management programs that encompasses interventional cardiologists, vascular surgeons and interventional radiologists. Nevertheless, it's important that practices develop programs and work toward consensus from all players, according to Tina Brinton, who spoke last week at the American College of Cardiovascular Administrators (ACCA) meeting.

Professional societies associated with vascular surgeons, neurosurgeons, interventional cardiologists and interventional radiologists each have established quality standards, but they don't all agree on the various metrics. That model is problematic especially since these disciplines are increasingly working together in hybrid cath labs or operating suites.

"Within each facility, each group has to agree on what they will establish as norms for quality management programs. They have to determine which of the indicators they are going to collect and how they will act upon them," said Brinton, a partner with Cenergy, a consulting firm that specializes in physician-hospital alliances.

The components of a quality management program are the indicators, comparative data, case review, structure and action. Indicator categories, for example, include clinical, efficiency, financial, value and market. Elements of the clinical category include complications, success, mortality and technique. Elements of efficiency include start times, case delays and length of stay. Market elements include market share, undiagnosed population and satisfaction. Financial elements are direct costs, supply costs, value and payor analyses, according to Brinton.

Comparative data can come from state organizations, professional organizations, commercial organizations and public sites. Objectives of case reviews are multiple including educational, prospective treatment planning-"very important in vascular right now," retrospective analysis to determine, for example, the efficacy of a particular therapy, and data abstraction for registry participation, among other reasons.

Structure is critical to the quality management program, Brinton said. There must be a clearly defined level of decision-making. The structure also must define the process including what action may be taken by programmatic structure, and what actions and when those actions will be referred to medical staff committee structure. "For example, when a particular threshold is exceeded, cases are sent to the surgical quality assurance committee for review. Recommendations from the surgical quality assurance committee will then proceed through established medical staff channels," Brinton explained.

Finally, the program should be action-oriented. "Action is critical to process improvement," she said. "If you're not going to do something with the data, don't collect it. No one has time to waste."

The key points, she stressed, are that quality management programs must include all the components-structure, review and action being the most important. In addition, all disciplines must be in agreement for the definitions of indicators and the process.

"Everyone has to understand that quality management programs in vascular are very difficult," Brinton said. "All the disciplines that participate in this terrain need to be at the table to help do everything. It needs to be integrated with the medical staff process, and it needs to come from the top of the organization. The top executive needs to be supportive of what happens within the quality management piece of vascular."