Sandhu Roopinder K, Wilton Stephen B, Cruz Jennifer, Aztema Clare L, MacFarlane Kendra, McKelvie Robert, Lambert Laurie, Rush Kathy, Zimmerman Rodney, Oakes Garth, Deyell Mark, Wyse D George, Cox Jafna L, Skanes Allan
Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
CJC Open. 2019 Jun 8;1(4):198-205. doi: 10.1016/j.cjco.2019.05.007. eCollection 2019 Jul.
In 2010, the Canadian Cardiovascular Society Atrial Fibrillation/Atrial Flutter (AF/AFL) quality indicator (QI) working group was established to develop QIs and assess feasibility of measurement. After extensive review, 3 priority QIs were selected. However, none were measurable at a national level.
The working group reconvened in 2017 to review the relevance of previously proposed QIs, identify opportunities to develop new QIs, and propose an initial strategy for measuring and reporting.
Two additional priority QIs were added to the previous 3: proportion of patients with nonvalvular (NV) AF/AFL sorted by stroke risk stratum and annual rate of hospitalization for a new heart failure diagnosis. An environmental scan was undertaken to determine the potential of existing databases to provide national and provincial estimates. On the basis of validated administrative codes, the Canadian Institute for Health Information discharge abstract database can be used for inpatients. In collaboration with the Canadian Primary Care Sentinel Surveillance Network, 2 of the 5 QIs can be assessed in outpatients (patients with NVAF/AFL sorted by stroke risk stratum and high risk for stroke NVAF/AFL receiving oral anticoagulation). Stroke prevention therapy can be further measured in selected provinces with linked databases including prescriptions.
This first step could provide a better initial understanding of the quality of AF/AFL care in Canada, but important gaps in the meaningful measurement of QIs remain. The AF/AFL QI working group has limited capacity to make progress without national level leadership and the resources to support data aggregation, data analysis, and pan-Canadian reporting.
2010年，加拿大心血管学会房颤/房扑（AF/AFL）质量指标（QI）工作组成立，旨在制定质量指标并评估测量的可行性。经过广泛审查，选定了3个优先质量指标。然而，在国家层面上没有一个是可测量的。
该工作组于2017年再次召开会议，以审查先前提出的质量指标的相关性，确定开发新质量指标的机会，并提出测量和报告的初步策略。
在前3个指标的基础上又增加了2个优先质量指标：按卒中风险分层分类的非瓣膜性（NV）AF/AFL患者比例以及新发心力衰竭诊断的年度住院率。进行了一项环境扫描，以确定现有数据库提供国家和省级估计值的潜力。基于经过验证的行政代码，加拿大卫生信息研究所出院摘要数据库可用于住院患者。与加拿大初级保健哨点监测网络合作，可以在门诊患者中评估5个质量指标中的2个（按卒中风险分层分类的NVAF/AFL患者以及接受口服抗凝治疗的高卒中风险NVAF/AFL患者）。在包括处方在内的有链接数据库的选定省份，可以进一步测量卒中预防治疗情况。
这第一步可以更好地初步了解加拿大AF/AFL护理的质量，但在有意义地测量质量指标方面仍存在重大差距。如果没有国家层面的领导以及支持数据汇总、数据分析和全加拿大报告的资源，AF/AFL质量指标工作组取得进展的能力将很有限。
