Medicine, University of Melbourne School of BioSciences, Melbourne, Victoria, Australia
Cardiology, GenesisCare, Alexandria, New South Wales, Australia.
Open Heart. 2022 May;9(1). doi: 10.1136/openhrt-2021-001797.
Despite rapid technological advances and growth, quality in imaging has not received the focus seen elsewhere in cardiovascular medicine, resulting in significant gaps between guidelines and practice. Contemporary echocardiography practice requires comprehensive real-time data collection to allow dynamic auditing and benchmarking of key performance indices. The American College of Cardiology (ACC) proposed additional data standardisation, structured reporting identifying key data elements and imaging registries. In the absence of an Australian echocardiography registry, we developed a national clinical quality registry (GenesisCare Cardiovascular Outcomes Echo Registry). We hypothesised that measurement and local reporting of data would improve compliance of echo studies with quality guidelines and hence their clinical value.
We prospectively collected data on 4 099 281 echocardiographic studies entered directly into a central electronic database from 63 laboratories across four Australian states between 2010 and 2021. Real-time auditing of key data elements and introduction of quality improvement pathways were performed to maximise completeness and uniformity of data acquisition and reporting. We compared completeness of key data element acquisition (AV peak velocity, left ventricular ejection fraction, E/e', LA area, rhythm, RVSP) by time and state using de-identified data. Key performance outcomes benchmarked against the aggregated study cohort and international standards were reported to individual sites to drive quality improvement. Between 2010 and 2014 there were significant improvements in data completeness (72.0%+/-26.8% vs 86.8%+/-13.5%, p=0.02), which were maintained to 2020. In addition, interstate variability fell for both EF and E/e' (p<0.002).
This large-scale collaboration provides a platform for the development of major quality improvement initiatives in echocardiography. Introduction of local quality assurance programmes via a unified national data set significantly improved the completeness of reporting of key echo quality measures. This in turn significantly improved the quality of, and reduced the interstate variability of, echo data. Developing a centralised database allowed rapid adoption nationally of local quality improvements.
尽管技术进步和发展迅速，但影像学质量并未像心血管医学其他领域那样受到关注，导致指南与实践之间存在显著差距。当代超声心动图实践需要全面的实时数据采集，以允许对关键性能指标进行动态审核和基准测试。美国心脏病学会 (ACC) 提出了额外的数据标准化、结构化报告，确定了关键数据元素和影像学注册。由于缺乏澳大利亚超声心动图注册，我们开发了一个全国性的临床质量注册（GenesisCare 心血管结局超声心动图注册）。我们假设对数据的测量和本地报告将提高超声心动图研究对质量指南的依从性，从而提高其临床价值。
我们前瞻性地收集了 2010 年至 2021 年间，来自澳大利亚四个州的 63 个实验室的 4099281 份超声心动图研究数据，这些数据直接输入中央电子数据库。通过实时审核关键数据元素并引入质量改进途径，最大限度地提高数据采集和报告的完整性和一致性。我们使用匿名数据比较了关键数据元素采集的完整性（AV 峰值速度、左心室射血分数、E/e'、LA 面积、节律、RVSP）随时间和州的变化。将关键绩效指标与汇总研究队列和国际标准进行基准测试，并向各个站点报告，以推动质量改进。2010 年至 2014 年，数据完整性有显著提高（72.0%+/-26.8%比 86.8%+/-13.5%，p=0.02），并一直保持到 2020 年。此外，EF 和 E/e'的州间变异性也有所下降（p<0.002）。
这项大规模合作提供了一个平台，可以在超声心动图领域开展重大质量改进计划。通过统一的国家数据集引入本地质量保证计划，显著提高了关键超声心动图质量指标报告的完整性。这反过来又显著提高了超声心动图数据的质量，并降低了州间的变异性。建立中央数据库允许在全国范围内迅速采用本地质量改进措施。
