PROs emerge as rich source for indicators
PROs emerge as rich source for indicators
Cardiac project to expand nationwide in 1997
For quality managers hungry for performance indicators and ways to measure them, the new focus of the peer review organizations (PROs) is a welcome change. A pilot cardiac project in several states, including Tennessee, shows how PROs supply indicator criteria, collect and analyze the resulting data, then give back benchmarking reports to participating hospitals.
The Cooperative Cardiovascular Project (CCP), set to expand nationwide in early 1997, focused on acute myocardial infarction criteria. CCP is a project sponsored by the Baltimore-based Health Care Financing Administration and carried out by PROs. The Tennessee PRO, Mid-South Foundation for Medical Care in Memphis, coordinated the CCP in that state.
The CCP’s criteria were developed by the Chicago-based American Medical Association, the Bethesda, MD-based American College of Cardiology, and the Dallas-based American Heart Association. Several of the measures will be modified, and others will be added.
Three areas targeted
HCFA’s overall project goal is to spur measurable improvement in three specific areas: timing of thrombolytics, aspirin at discharge, and utilization of beta blockers with ideal candidates.
The quality indicators are divided into five topic areas, with specific measures:
• Reperfusion:
confirmed acute MI patients, thrombolytics or percutaneous transluminal coronary angioplasty within 12 hours of arrival at hospital;
timing of thrombolytics;
timing of primary angioplasty.
• Beta blockers:
utilization of beta blockers in ideal candidates;
utilization of beta blockers in an expanded cohort of ideal candidates.
• Aspirin:
aspirin during hospitalization;
timing of aspirin;
aspirin at discharge.
• Management of patients with poor left ventricle function:
use of ACE inhibitors;
avoidance of calcium channel blockers.
• Risk factor modification:
Smoking cessation counseling.
After the indicator data was compiled the first time, hospitals received reports with data not only on their facility, but also 10 similarly sized organizations along with statewide percentages and national data. But the PROs’ work didn’t end there.
Participating hospitals can continue to collect data for the above indicators and submit it to the PRO, and the PRO will collate the information allowing the hospital to track its progress. The hospital may even include information on non-Medicare acute MI patients.
"The hospitals have the opportunity to benchmark themselves almost constantly," says Stephen Winbery, PhD, MD, principal clinical coordinator with Mid-South Foundation. (See performance indicator results of Tennessee project, this page.)
Winbery and his staff have seen hundreds of quality improvement (QI) plans relating to every measure in these projects, making them experts in what will and will not likely work. They offer this expertise to hospitals free of charge. Many participating hospitals in Tennessee have given their proposed QI program to Winbery for review, and he has suggested modifications.
Their comments are not limited to strict clinical outcomes. "We look at things that they don’t think about, like cost," Winbery says. "We might say, This plan is wonderful, but we don’t think you can do this cost effectively. It’s too elaborate.’"
QI resources available
If the hospital is at a loss on how to go about a QI plan, Winbery makes available tried-and-true plans from other hospitals. Information identifying plan authors are eliminated, and the hospital may choose from several selections.
"Over the course of two or three months, they develop some pretty sophisticated [QI] plans," Winbery says.
"It was no different than if I hired them as consultants to assess our standard of care in our cardiac care area," says Drew Gaffney, MD, FACC, chief of clinical cardiology at Vanderbilt University Medical Center in Nashville, TN, one of the first institutions to participate in the Cooperative Cardiology Project. He describes the interaction between the hospital and Mid-South as collegial and collaborative.
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