Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Cardiovascular Outcomes, Quality, and Evaluative Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania, USA; Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
JACC Cardiovasc Interv. 2020 Dec 28;13(24):2853-2864. doi: 10.1016/j.jcin.2020.09.002.
The aim of this study was to enumerate and categorize quality metrics relevant to the pediatric/congenital cardiac catheterization laboratory (PCCL).
Diagnostic and interventional catheterization procedures are an increasingly important part of the care of young patients with cardiac disease. Measurement of the performance of PCCL programs in a stringent and consistent fashion is a crucial step toward improving outcomes. To the best of our knowledge, a systematic evaluation of current quality metrics in PCCL has not been performed previously.
Potential metrics were evaluated by: 1) a systematic review of peer-reviewed research; 2) a review of metrics from organizations interested in quality improvement, patient safety, and/or PCCL programs; and 3) a survey of U.S. PCCL cardiologists. Collected metrics were grouped on 2 dimensions: 1) Institute of Medicine domains; and 2) the Donabedian structure/process/outcome framework. Survey responses were dichotomized between favorable and unfavorable responses and then compared within and between categories.
In the systematic review, 6 metrics were identified (from 9 publications), all focused on safety either as an outcome (adverse events [AEs], mortality, and failure to rescue along with radiation exposure) or as a structure (procedure volume or operator experience). Four organizations measure quality metrics of PCCL programs, of which only 1 publicly reports data. For the survey, 229 cardiologists from 118 hospital programs responded (66% of individuals and 72% of hospital programs). The highest favorable ratings were for safety metrics (p < 0.001), of which major AEs, failure to rescue, and procedure-specific AEs had the highest ratings. Of respondents, 67% stated that current risk adjustment were not effective. Favorability ratings for hospital characteristics, PCCL characteristics, and quality improvement processes were significantly lower than for safety and less consistent within categories.
There is a limited number of PCCL quality metrics, primarily focused on safety. Confidence in current risk adjustment methodology is low. The knowledge gaps identified should guide future research in the development of new quality metrics.
本研究旨在列举和分类与儿科/先天性心脏导管实验室（PCCL）相关的质量指标。
诊断和介入导管术是患有心脏疾病的年轻患者治疗中越来越重要的一部分。严格和一致地衡量 PCCL 计划的绩效是改善结果的关键步骤。据我们所知，以前尚未对 PCCL 中的当前质量指标进行系统评估。
通过以下方式评估潜在指标：1）对同行评议研究进行系统回顾；2）审查对质量改进、患者安全和/或 PCCL 计划感兴趣的组织的指标；3）对美国 PCCL 心脏病专家进行调查。收集的指标按 2 个维度进行分组：1）美国国家医学研究院（IOM）领域；2）Donabedian 结构/过程/结果框架。将调查答复分为有利和不利答复，然后在类别内和类别之间进行比较。
在系统评价中，确定了 6 项指标（来自 9 篇出版物），均侧重于安全性，既作为结果（不良事件[AE]、死亡率和未能挽救以及辐射暴露），也作为结构（程序量或操作人员经验）。有 4 个组织衡量 PCCL 计划的质量指标，其中只有 1 个组织公开报告数据。在调查中，来自 118 个医院计划的 229 位心脏病专家做出了回应（占个人的 66%和医院计划的 72%）。安全性指标的评价最高（p<0.001），其中重大 AE、未能挽救和特定程序 AE 的评价最高。67%的受访者表示，当前的风险调整方法效果不佳。医院特征、PCCL 特征和质量改进过程的评价率明显低于安全性，并且在类别内不一致。
PCCL 质量指标数量有限，主要集中在安全性上。对当前风险调整方法的信心较低。确定的知识空白应指导未来研究开发新的质量指标。
