ACCF/AHA methodology for the development of quality measures for cardiovascular technology: A report of the american college of cardiology foundation/american heart association task force on performance measures

Robert O. Bonow*, Pamela S. Douglas, Alfred E. Buxton, David J. Cohen, Jeptha P. Curtis, Elizabeth Delong, Joseph P. Drozda, T. Bruce Ferguson, Paul A. Heidenreich, Robert C. Hendel, Frederick A. Masoudi, Eric D. Peterson, Allen J. Taylor

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Consistent with the growing national focus on healthcare quality, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have taken a leadership role over the past decade in developing measures of the quality of cardiovascular care by convening a joint ACCF/AHA Task Force on Performance Measures. The Task Force is charged with identifying the clinical topics appropriate for the development of performance measures and with assembling writing committees composed of clinical and methodological experts in collaboration with appropriate subspecialty societies. The Task Force has also created methodology documents that offer guidance in the development of process, outcome, composite, and efficiency measures. Cardiovascular performance measures using existing ACCF/AHA methodology are based on Class I or Class III guidelines recommendations, usually with Level A evidence. These performance measures, based on evidence-based ACCF/AHA guidelines, remain the most rigorous quality measures for both internal quality improvement and public reporting. However, many of the tools for diagnosis and treatment of cardiovascular disease involve advanced technologies, such as cardiac imaging, for which there are often no underlying guideline documents. Because these technologies affect the quality of cardiovascular care and also have the potential to contribute to cardiovascular health expenditures, there is a need for more critical assessment of the use of technology, including the development of quality and performance measures in areas in which guideline recommendations are absent. The evaluation of quality in the use of cardiovascular technologies requires consideration of multiple parameters that differ from other healthcare processes. The present document describes methodology for development of 2 new classes of quality measures in these situations, appropriate use measures and structure/safety measures. Appropriate use measures are based on specific indications, processes, or parameters of care for which high level of evidence data and Class I or Class III guideline recommendations may be lacking but are addressed in ACCF appropriate use criteria documents. Structure/safety measures represent measures developed to address structural aspects of the use of healthcare technology (e.g., laboratory accreditation, personnel training, and credentialing) or quality issues related to patient safety when there are neither guidelines recommendations nor appropriate use criteria. Although the strength of evidence for appropriate use measures and structure/safety measures may not be as strong as that for formal performance measures, they are quality measures that are otherwise rigorously developed, reviewed, tested, and approved in the same manner as ACCF/AHA performance measures. The ultimate goal of the present document is to provide direction in defining and measuring the appropriate useavoiding not only underuse but also overuse and misuseand proper application of cardiovascular technology and to describe how such appropriate use measures and structure/safety measures might be developed for the purposes of quality improvement and public reporting. It is anticipated that this effort will help focus the national dialogue on the use of cardiovascular technology and away from the current concerns about volume and cost alone to a more holistic emphasis on value.

Original languageEnglish (US)
Pages (from-to)1517-1538
Number of pages22
JournalJournal of the American College of Cardiology
Volume58
Issue number14
DOIs
StatePublished - Sep 27 2011

Funding

The work of the writing committee was supported exclusively by the ACCF and AHA. Writing committee members volunteered their time, and there was no commercial support for the development of this performance methodology. Writing committee members were required to disclose in writing all current financial relationships with industry and other entities, as well as those 12 months before initiation of the writing effort, and verbally acknowledge these relationships to the other members at each meeting ( Appendix A ), in accordance with standard ACCF and AHA reporting policies. In addition, peer reviewers of the document were asked to disclose relationships with industry and other entities ( Appendix B ). The parent Task Force makes every effort to avoid actual, potential, or perceived conflicts of interest that may arise as a result of industry relationships or personal interests among the writing committee. Because this is a methodology document, the recommendations will not benefit or harm any company. Consequently, the Task Force has determined that members' relationships with pharmaceutical companies and device manufacturers are not relevant to the topic of this document. Authors' comprehensive disclosure information, which includes information on relationships with industry and other entities not relevant to this document, is available online at http://content.onlinejacc.org/cgi/content/full/j.jacc.2011.07.007/DC1 .

Keywords

  • ACCF/AHA Performance Measures
  • quality assessment, healthcare
  • quality indicators, healthcare
  • technology, medical

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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