Elsevier

American Heart Journal

Volume 235, May 2021, Pages 97-103
American Heart Journal

Clinical Investigations
Interventional cardiologists’ perceptions of percutaneous coronary intervention quality measurement and feedback

https://doi.org/10.1016/j.ahj.2021.01.019Get rights and content

Background

Interventional cardiologists receive feedback on their clinical care from a variety of sources including registry-based quality measures, case conferences, and informal peer interactions. However, the impact of this feedback on clinical care is unclear.

Methods

We interviewed interventional cardiologists regarding the use of feedback to improve their care of percutaneous coronary intervention (PCI) patients. Interviews were assessed with template analysis using deductive and inductive techniques.

Results

Among 20 interventional cardiologists from private, academic, and Department of Veterans Affairs practice, 85% were male, 75% performed at least 100 PCIs annually, and 55% were in practice for 5 years or more. All reported receiving feedback on their practice, including formal quality measures and peer learning activities. Many respondents were critical of quality measure reporting, citing lack of trust in outcomes measures and poor applicability to clinical care. Some respondents reported the use of process measures such as contrast volume and fluoroscopy time for benchmarking their performance. Case conferences and informal peer feedback were perceived as timelier and more impactful on clinical care. Respondents identified facilitators of successful feedback interventions including transparent processes, respectful and reciprocal peer relationships, and integration of feedback into collective goals. Hierarchy and competitive environments inhibited useful feedback.

Conclusions

Despite substantial resources dedicated to performance measurement and feedback for PCI, interventional cardiologists perceive existing quality measures to be of only modest value for improving clinical care. Catherization laboratories should seek to integrate quality measures into a holistic quality program that emphasizes peer learning, collective goals and mutual respect.

Section snippets

Materials and methods

Respondents were solicited using a snowball sample technique to recruit interventional cardiologists in active practice at a variety of practice locations. Personal contacts of the study team were initially approached, who then provided referrals to colleagues. Veterans Affairs (VA) cardiologists were under-represented in the initial sample, so subsequent recruitment drew from participants completing a related online survey of VA cardiologists.15 From August 2018 to March 2020, we approached a

Results

A total of 20 interventional cardiologists participated, including 7 in private practice, 5 in academic practice, and 8 with primary appointment at a VA hospital. Of the VA cardiologists, 5 reported also performing PCIs at an academic affiliate hospital. Most participants were male. Years in practice ranged from 1 to 35, and all participants reported annual volume of at least 60 PCIs. Four participants self-identified as holding leadership positions in their catheterization laboratory or

Discussion

These interviews provide a unique description of feedback sources and mechanisms among a diverse group of practicing interventional cardiologists. Registry-based quality measure reporting is ubiquitous, but viewed with skepticism or frustration by many of our respondents. Peer feedback through case conferences or informal interactions with colleagues was perceived as more useful to assess performance and more likely to promote practice change. Overall, interventional cardiologists report a

Conclusions

Interventional cardiologists in our study valued feedback that helped them improve their performance and their patients’ outcomes. Each feedback method had reported strengths and weaknesses. A holistic system to monitor and improve PCI quality likely requires a combination of quality measure reporting, formal QI processes, and informal peer learning. Hospitals and interventional cardiology groups can promote more effective feedback by adopting transparent processes, encouraging respectful and

Funding

This work was funded by the Locke Charitable Trust Fund and Dr. Doll's VA Career Development Award (1IK2HX002590).

Acknowledgments

We acknowledge Carol Simons for her support performing interviews and qualitative analysis. Ms. Simons is an employee of VA Puget Sound and was not otherwise compensated for her assistance with this study. She has provided written permission to be included in this acknowledgment.

Dr. Hira reports honoraria from Asahi Intec and Abbott Vascular. Dr. Waldo receives investigator-initiated research support to the Denver Research Institute from Abiomed, Cardiovascular Systems Incorporated, and Merck

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