PMID- 33357522
OWN - NLM
STAT- MEDLINE
DCOM- 20210811
LR  - 20211229
IS  - 1876-7605 (Electronic)
IS  - 1936-8798 (Print)
IS  - 1936-8798 (Linking)
VI  - 13
IP  - 24
DP  - 2020 Dec 28
TI  - Pediatric/Congenital Cardiac Catheterization Quality: An Analysis of Existing 
      Metrics.
PG  - 2853-2864
LID - S1936-8798(20)31808-2 [pii]
LID - 10.1016/j.jcin.2020.09.002 [doi]
AB  - OBJECTIVES: The aim of this study was to enumerate and categorize quality metrics 
      relevant to the pediatric/congenital cardiac catheterization laboratory (PCCL). 
      BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
CI  - Copyright (c) 2020 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - O'Byrne, Michael L
AU  - O'Byrne ML
AD  - 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. Electronic address: 
      obyrnem@email.chop.edu.
FAU - Huang, Jing
AU  - Huang J
AD  - 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.
FAU - Asztalos, Ivor
AU  - Asztalos I
AD  - 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.
FAU - Smith, Christopher L
AU  - Smith CL
AD  - 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.
FAU - Dori, Yoav
AU  - Dori Y
AD  - 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.
FAU - Gillespie, Matthew J
AU  - Gillespie MJ
AD  - 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.
FAU - Rome, Jonathan J
AU  - Rome JJ
AD  - 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.
FAU - Glatz, Andrew C
AU  - Glatz AC
AD  - 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.
LA  - eng
GR  - K23 HL130420/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Systematic Review
PL  - United States
TA  - JACC Cardiovasc Interv
JT  - JACC. Cardiovascular interventions
JID - 101467004
SB  - IM
CIN - JACC Cardiovasc Interv. 2020 Dec 28;13(24):2865-2867. PMID: 33357523
MH  - *Benchmarking
MH  - *Cardiac Catheterization
MH  - Child
MH  - Hospitals
MH  - Humans
MH  - Quality Improvement
MH  - Treatment Outcome
PMC - PMC7773132
MID - NIHMS1648455
OTO - NOTNLM
OT  - heart catheterization
OT  - metric
OT  - pediatrics
OT  - performance measure
OT  - quality
OT  - safety
COIS- Author Disclosures Dr. O'Byrne has received research support from the National 
      Institute of Health/National Heart, Lung, and Blood Institute (grant K23 
      HL130420-01). The funding agencies had no role in the planning or execution of 
      the study, nor did they edit the paper as presented. The paper represents the 
      opinions of the authors alone. All other authors have reported that they have no 
      relationships relevant to the contents of this paper to disclose.
EDAT- 2020/12/29 06:00
MHDA- 2021/08/12 06:00
PMCR- 2021/12/28
CRDT- 2020/12/28 10:17
PHST- 2020/07/08 00:00 [received]
PHST- 2020/08/19 00:00 [revised]
PHST- 2020/09/01 00:00 [accepted]
PHST- 2020/12/28 10:17 [entrez]
PHST- 2020/12/29 06:00 [pubmed]
PHST- 2021/08/12 06:00 [medline]
PHST- 2021/12/28 00:00 [pmc-release]
AID - S1936-8798(20)31808-2 [pii]
AID - 10.1016/j.jcin.2020.09.002 [doi]
PST - ppublish
SO  - JACC Cardiovasc Interv. 2020 Dec 28;13(24):2853-2864. doi: 
      10.1016/j.jcin.2020.09.002.