Characteristics of the Quality Improvement Content of Cardiac Catheterization Peer Reviews in the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program
Characteristics of the Quality Improvement Content of Cardiac Catheterization Peer Reviews in the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program
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DOI：
10.1001/jamanetworkopen.2019.8393
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发表时间：
2019-08-01
影响因子：
13.8
通讯作者：
Waldo, Stephen W.
中科院分区：
文献类型：
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作者：
Doll, Jacob A.;Plomondon, Mary E.;Waldo, Stephen W.
重要性同行评议是所有心导管项目质量评估的推荐方法，但是，据我们所知，同行评议的内容和质量改进的潜力尚未被描述。目的探讨心导管术同行评议的质量改进内容。设计、环境和参与者：本质量改进研究采用回顾性病例综述，对2012年1月1日至2016年12月31日期间美国退伍军人事务部临床评估、报告和跟踪（CART）项目的诊断性血管造影和经皮冠状动脉介入手术进行评估。数据审查和分析于2017年11月至2018年8月进行。主要结果和测量方法同行评议报告不合格护理和质量改进机会的百分比。结果退伍军人事务部共进行诊断性冠状动脉造影196643例，经皮冠状动脉介入治疗62576例。其中，168例（0.1%）因在手术过程中自我报告的主要不良事件而被触发审查。在152例具有完整同行评议数据的病例中，25例（16.4%）的护理被裁定为不符合护理标准。对操作员判断的担忧有46例（30.3%），对病例选择的担忧有26例（17.1%），对学员监督的担忧有21例（13.8%），对技术表现的担忧有46例（30.3%）。审稿人在63例（41.4%）和58例（38.2%）的导尿实验室或医院流程中提出了改善操作人员绩效的建议。结论和意义虽然在退伍军人事务部导管实验室并发症的同行评议中，不合格的护理很少被发现，但这一过程通常会产生质量改进的建议。同行评议项目应侧重于识别质量改进机会，并向运营商提供有意义的反馈。
IMPORTANCE Peer review is recommended for quality assessment in all cardiac catheterization programs, but, to our knowledge, the content of peer reviews and the potential for quality improvement has not been described.OBJECTIVE To characterize the quality improvement content of cardiac catheterization peer reviews.DESIGN, SETTING, AND PARTICIPANTS This quality improvement study used retrospective case review of diagnostic angiography and percutaneous coronary intervention procedures to characterize the major adverse event review process of the US Department of Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) program from January 1, 2012, to December 31, 2016. Data review and analysis took place from November 2017 to August 2018.MAIN OUTCOMES AND MEASURES Percentage of peer reviews reporting substandard care and opportunities for quality improvement.RESULTS A total of 196 643 diagnostic coronary angiograms and 62 576 percutaneous coronary interventions were performed in the Department of Veterans Affairs. Of these, 168 (0.1%) were triggered for review because of a self-reported major adverse event during the procedure. Of 152 cases with complete peer review data, carewas adjudicated as not meeting the standard of care in 25 cases (16.4%). Concerns about operator judgment were identified in 46 cases (30.3%), about case selection in 26 (17.1%), about trainee supervision in 21 (13.8%), and about technical performance in 46 (30.3%). Reviewers made recommendations to improve operator performance in 63 cases (41.4%) and catheterization laboratory or hospital processes in 58 (38.2%).CONCLUSIONS AND RELEVANCE While substandard care is infrequently identified in peer review of catheterization laboratory complications in the Department of Veterans Affairs, the process often generates recommendations for quality improvement. Peer review programs should focus on identifying quality improvement opportunities and providing meaningful feedback to operators.