University of Washington, Seattle, WA.
University of Washington, Seattle, WA; VA Puget Sound Health Care System, Seattle, WA.
Am Heart J. 2021 May;235:97-103. doi: 10.1016/j.ahj.2021.01.019. Epub 2021 Feb 7.
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.
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.
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.
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.
介入心脏病学家从多种来源（包括基于注册的质量指标、病例会议和非正式同行交流）获得其临床护理的反馈。然而，这种反馈对临床护理的影响尚不清楚。
我们采访了介入心脏病学家，了解他们如何利用反馈来改善经皮冠状动脉介入治疗 (PCI) 患者的护理。使用演绎和归纳技术对访谈进行模板分析。
在来自私人、学术和退伍军人事务部实践的 20 名介入心脏病学家中，85%为男性，75%每年至少进行 100 次 PCI，55%从业 5 年或以上。所有人都报告收到了关于其实践的反馈，包括正式的质量指标和同行学习活动。许多受访者对质量指标报告持批评态度，指出他们对结果指标缺乏信任，以及对临床护理的适用性较差。一些受访者报告使用了过程指标，如对比剂用量和透视时间，来衡量自己的表现。病例会议和非正式同行反馈被认为对临床护理更及时、更有影响力。受访者确定了成功反馈干预的促进因素，包括透明的流程、尊重和互惠的同行关系，以及将反馈纳入集体目标。等级制度和竞争环境抑制了有用的反馈。
尽管 PCI 投入了大量资源用于绩效衡量和反馈，但介入心脏病学家认为现有的质量指标对改善临床护理的价值有限。导管实验室应寻求将质量指标纳入强调同行学习、集体目标和相互尊重的整体质量计划中。
