Reed Miller

May 09, 2011

May 6, 2011 (Baltimore, Maryland) — The recent efforts of the Society for Cardiovascular Angiography and Interventions (SCAI) to improve patient care and maintain public trust in cath labs picked up steam with the launch of a five-part national quality program here at Society for Cardiovascular Angiography and Interventions 2011 Scientific Sessions [1].

The location of the meeting is especially appropriate, as Maryland has become the primary battleground for SCAI's struggle to increase oversight of cardiac catheterization labs and prevent unnecessary procedures. As reported by heartwire , SCAI is spearheading a so-far-unsuccessful effort to mandate cath-lab accreditation in Maryland as accusations that Maryland interventionalist Dr Mark Midei implanted many stents unnecessarily continues to make news in the Old Line State.

"We as a profession really need to step up to the plate and acknowledge that we have not done a good job at regulating ourselves," Dr Gregory Dehmer (Texas A&M University College of Medicine, Temple) said during a session on quality improvement. "We as a profession have to take charge of this, because it is a privilege to be able to regulate ourselves, and if we don't do this it will be taken away. That's where the answer is: local facilities getting together and saying, 'This is something we have to do.' "

To help cath labs improve their quality of care, SCAI launched the Quality Improvement Toolkit at a well-attended workshop at the conference. The toolkit includes a collection of educational materials that cath-lab leaders can use to improve the quality-control procedures at their center. Topics covered include professional guidelines, how to conduct peer-review conferences and random case reviews, national database participation and data collection, preprocedure checklists, and inventory management. SCAI hopes to have at least 125 hospitals using the toolkit by the end of the year.

"This is not a one-time thing," former SCAI president and current chief medical officer of the Accreditation for Cardiovascular Excellence (ACE) program, Dr Bonnie Weiner (Saint Vincent Hospital, Worcester, MA), emphasized. "Accreditation is an ongoing process; peer review is an ongoing process. . . . These are things that should be ingrained into the fabric of our existence so that, moving forward, we are not subject to the kind of external vilification that we've been subjected to in some cases. It's up to us to take ownership of that."

The second part of SCAI's program is accreditation of cath labs. Weiner's ACE organization announced it had completed its first accreditation of an angioplasty/stenting program--at Bon Secours St Francis Health System in South Carolina--and ACE is working with about a half-dozen more centers hoping to be accredited by the end of 2011. "It's not a one-stop shop. You don't get your stamp and move on. This is an ongoing process. We see this as a way to continue to improve the quality of care throughout the country, and it's an important piece for reestablishing and perpetuating patient trust in the healthcare that they're receiving," Weiner said at a press conference about the quality program. Incoming SCAI president Dr Christopher White (Ochsner Medical Center, New Orleans, LA) added that ACE's and SCAI's quality training programs are "completely independent, which is what I think gives the accreditation strength."

In addition to the quality-improvement toolkit and the ACE accreditation process, the other three parts of the program that SCAI is also promoting are third-party peer review, measurement and public reporting, and patient and physician education.

SCAI released a white paper entitled the Quality Imperative: Lessons from the Cath Lab [2]. In it, SCAI calls for a system of continuous quality improvement in each cath lab. A key component of this effort must be cath-lab conferences where physician peers review randomly selected cases. "Just as good drivers learn from 'fender benders,' good physicians learn from procedures that result in complications," the paper explains. "Likewise, just as we need to go beyond traffic reports to assess the quality of a driver, we need to go beyond complication rates to assess the quality of the physician."

These are things that should be ingrained into the fabric of our existence so that, moving forward, we are not subject to the kind of external vilification that we've been subjected to.

The society also released a two-part position statement on public reporting and risk adjustment from a committee led by Dr Lloyd Klein (Rush Medical Center, Chicago, IL) [3]. The paper advocates measuring and benchmarking quality with risk-adjusted clinical data in national databases or validated case reports, instead of administrative claims data. "Interventional cardiologists are best suited to perform the primary role in evaluating PCI quality and guiding a program focused on objective measures. The process must not be payer or hospital-administration directed, as these stakeholders may have conflicting goals," Klein and colleagues argue. "Nevertheless, quality will have important reimbursement ramifications in the future. . . . Active physician participation in developing the tools to measure and report quality outcomes is essential; otherwise, control over the process will be lost to those who do not possess an in-depth comprehension of interventional practice."

SCAI is also continuing to promote its "Know What Counts" community educational series, in which local physicians and well-known faculty meet with patients to talk about cardiovascular disease. At these events, "you'll learn about the whole story behind the oversimplified headlines often published by the mainstream press," SCAI promises on its website.

SCAI's Quality Improvement Toolkit was developed in collaboration with Daiichi Sankyo/Lilly. White is on the advisory boards of St Jude, Neovasc, and Baxter Cellular Therapy. Weiner consults for several companies, including Boston Scientific.