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May 6, 2020

Performance Metrics to Improve Quality in Contemporary Percutaneous Coronary Intervention Practice

Author Affiliations
  • 1University of California, San Francisco, San Francisco
  • 2University of Texas Health Science Center, Houston
  • 3Duke Clinical Research Institute, Durham, North Carolina
JAMA Cardiol. Published online May 6, 2020. doi:10.1001/jamacardio.2020.0904

Assessing the quality of care delivered by percutaneous coronary intervention (PCI) programs and individual operators requires an effective ongoing evaluation process relevant to contemporary practice with appropriate benchmarks for comparison.1-3 This is a complex undertaking because no single metric or system to define quality exists; rather, the domains of quality are composed of multiple elements, including effectiveness, safety, appropriateness, and value, each of which is difficult to quantify. Furthermore, there is only general agreement on the relative importance of many competing ideals, principles, and goals. Different stakeholders have vastly divergent notions of needs and quality, and there are multiple valid viewpoints. Health care insurance payors, rating agencies, hospital systems, hospital administrators, physicians, patients, and regulators each assess quality from their own perspective, but none adequately capture its totality. Moreover, powerful economic forces drive the motivation to capture a larger market share, perform more procedures to remain competitive and financially viable, and ultimately generate more income. These are the concerns to which those implementing a quality-assessment mechanism and the metrics in a quality-appraisal process must react and adapt enthusiastically.

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