As healthcare continues to shift toward prioritizing value over volume, what is the best way to determine—and improve—the quality of a percutaneous coronary intervention (PCI) program? The authors of a new commentary in JAMA Cardiology explored this subject at length, noting that assuring PCI quality remains “an enduring challenge.”  

“Different stakeholders have vastly divergent notions of needs and quality, and there are multiple valid viewpoints,” wrote Lloyd W. Klein, MD, University of California, San Francisco, and colleagues. “Health care insurance payors, rating agencies, hospital systems, hospital administrators, physicians, patients, and regulators each assess quality from their own perspective, but none adequately capture its totality. Moreover, powerful economic forces drive the motivation to capture a larger market share, perform more procedures to remain competitive and financially viable, and ultimately generate more income. These are the concerns to which those implementing a quality-assessment mechanism and the metrics in a quality-appraisal process must react and adapt enthusiastically.”

Klein et al. emphasized the importance of identifying the right performance metrics and incentives. Collaborations between stakeholders are vital when it comes to making these decisions, and relative value unit (RVU) production should not be the sole way an employee can be recognized.

The authors also noted that quality improvement efforts should focus on improving “internal efforts” whenever possible.

“Clinicians are responsible for developing and implementing internal quality assurance systems not only by moral obligation but also by external accreditation requirements,” they wrote. “Leaders must set high performance standards and communicate the specific elements in every setting, so that they are not viewed as merely politically correct advertising but as a real aspiration, which is a message of paramount importance.”