Indicators of Quality of Care for Patients with Acute Myocardial Infarction

The Institute for Clinical Evaluative Sciences, Toronto, Ont.
Canadian Medical Association Journal (Impact Factor: 5.96). 11/2008; 179(9):909-15. DOI: 10.1503/cmaj.080749
Source: PubMed


There is a wide practice gap between optimal and actual care for patients with acute myocardial infarction in hospitals around the world. We undertook this initiative to develop an updated set of evidence-based indicators to measure and improve the quality of care for this patient population.
A 12-member expert panel was convened in 2007 to develop an updated set of quality indicators for acute myocardial infarction. The panel identified a list of potential indicators after reviewing the scientific literature, clinical practice guidelines and other published quality indicators. To develop the new list of indicators, the panel rated each potential indicator on 4 dimensions (reliability, validity, feasibility and usefulness in improving patient outcomes) and discussed the top-ranked quality indicators at a consensus meeting.
Consensus was reached on 38 quality indicators: 17 that would be measurable using chart-abstracted data and 21 that would be measurable using administrative data. Of the 17 chart-review indicators, 13 address pharmacologic and nonpharmacologic care delivered to patients in hospital. In-hospital mortality was recommended as a key outcome indicator. Three system indicators were recommended to measure the collaborative responsiveness of the health care system from the call for help to intervention. It was recommended that hospitals strive for a minimum target benchmark of 90% or greater on process-of-care indicators.
Implementation of strategies by clinicians and hospitals to meet target benchmarks on these quality indicators could save the lives of many individuals with acute myocardial infarction.

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    • "The importance of implementation strategies is often referred to in the course of critical appraisal of guidelines [42]. As for guideline development, implementation strategies are indispensable for the real-life application of QIs [58]. Our results show that even though a wide variety of implementation strategies are reported, they are not always part of the QI development process. "
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    • "Finally, there may be limitations in the technical quality of care measures used in the present study. Although there is consensus around many of these indicators, the 14 measures used in this study do not entirely overlap with other proposed sets of quality of care indicators (Tu et al. 2008). Thus, a different result may have been obtained regarding the impact of technical quality if additional measures had been included, such as those related to postdischarge out-of-hospital care. "
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    • "This 60-minute time constraint has been used in previous studies of access to PCI.21,29 In Canada, a recent quality-of-care indicator for acute myocardial infarction (AMI) is reperfusion within 120 minutes from first medical contact.30 Recognizing this longer window, we considered additional pre-hospital transportation times of 90 and 120 minutes. "
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