退伍军人事务临床评估、报告和跟踪计划中心脏导管检查同行评议质量改进内容的特征。
Characteristics of the Quality Improvement Content of Cardiac Catheterization Peer Reviews in the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.
机构信息
Section of Cardiology, VA Puget Sound Health Care System, Seattle, Washington.
Division of Cardiology, Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado.
出版信息
JAMA Netw Open. 2019 Aug 2;2(8):e198393. doi: 10.1001/jamanetworkopen.2019.8393.
IMPORTANCE
Peer review is recommended for quality assessment in all cardiac catheterization programs, but, to our knowledge, the content of peer reviews and the potential for quality improvement has not been described.
OBJECTIVE
To characterize the quality improvement content of cardiac catheterization peer reviews.
DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study used retrospective case review of diagnostic angiography and percutaneous coronary intervention procedures to characterize the major adverse event review process of the US Department of Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) program from January 1, 2012, to December 31, 2016. Data review and analysis took place from November 2017 to August 2018.
MAIN OUTCOMES AND MEASURES
Percentage of peer reviews reporting substandard care and opportunities for quality improvement.
RESULTS
A total of 196 643 diagnostic coronary angiograms and 62 576 percutaneous coronary interventions were performed in the Department of Veterans Affairs. Of these, 168 (0.1%) were triggered for review because of a self-reported major adverse event during the procedure. Of 152 cases with complete peer review data, care was adjudicated as not meeting the standard of care in 25 cases (16.4%). Concerns about operator judgment were identified in 46 cases (30.3%), about case selection in 26 (17.1%), about trainee supervision in 21 (13.8%), and about technical performance in 46 (30.3%). Reviewers made recommendations to improve operator performance in 63 cases (41.4%) and catheterization laboratory or hospital processes in 58 (38.2%).
CONCLUSIONS AND RELEVANCE
While substandard care is infrequently identified in peer review of catheterization laboratory complications in the Department of Veterans Affairs, the process often generates recommendations for quality improvement. Peer review programs should focus on identifying quality improvement opportunities and providing meaningful feedback to operators.
重要性
同行评议被推荐用于所有心脏导管插入术计划的质量评估，但据我们所知，同行评议的内容和质量改进的潜力尚未描述。
目的
描述心脏导管插入术同行评议的质量改进内容。
设计、设置和参与者：这项质量改进研究使用回顾性病例审查诊断性血管造影术和经皮冠状动脉介入治疗程序，以描述美国退伍事务部临床评估、报告和跟踪（CART）计划从 2012 年 1 月 1 日至 2016 年 12 月 31 日的主要不良事件审查过程。数据审查和分析于 2017 年 11 月至 2018 年 8 月进行。
主要结果和措施
报告护理标准不达标和质量改进机会的同行评议比例。
结果
在退伍事务部共进行了 19643 例诊断性冠状动脉造影术和 62576 例经皮冠状动脉介入术。其中，168 例（0.1%）因术中报告的重大不良事件而触发审查。在 152 例有完整同行评议数据的病例中，25 例（16.4%）的护理被裁定不符合护理标准。在 46 例（30.3%）中发现了对操作人员判断的关注，在 26 例（17.1%）中发现了对病例选择的关注，在 21 例（13.8%）中发现了对学员监督的关注，在 46 例（30.3%）中发现了对技术表现的关注。审查员提出了改善操作人员表现的建议 63 例（41.4%）和改善导管实验室或医院流程的建议 58 例（38.2%）。
结论和相关性
虽然在退伍事务部心脏导管插入术并发症的同行评议中很少发现护理标准不达标，但该过程通常会产生质量改进的建议。同行评议计划应侧重于确定质量改进机会并向操作人员提供有意义的反馈。
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