DALLAS, March 28 -- No one doubts the importance of measuring the quality of healthcare delivered to heart patients. Yet doing so is a complex challenge that will require extensive research and rigorous new standards before the nation can accurately gauge just how well these patients are faring and improve their care and outcome, says a new report in today's Circulation: Journal of the American Heart Association.
"There is evidence of great variation in care," says Harlan M. Krumholz, M.D., associate professor of medicine at Yale School of Medicine. "Similar patients can be treated very differently in different towns and regions of the country. We need to be able to measure what we do in order to ensure that all patients get the very best care."
The American Heart Association and the American College of Cardiology have taken a leadership role in responding to challenges set forth by a variety of governmental bodies and special interest groups to look at how the delivery of cardiovascular care can be measured and what improvements are needed. The two organizations convened a panel of experts last May. Findings from the First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke provide a detailed road map to follow in devising reliable performance standards.
"There have been a lot of concerns expressed lately about gaps and inadequacies in the healthcare system," says Krumholz, who chaired the forum. "This report represents an important effort by physicians and researchers to address some of these concerns by developing a way we can actually measure the quality of care that is being delivered."
Krumholz says that ultimately these performance measures will help save lives.
The panel issued strong warnings against the use of simplistic methods to measure the quality of care being provided by physicians and hospitals. The panel adds that many of the so-called "report cards" published by a number of organizations are not valid and rely more on administrative claims data than on actual patient care information.
Even more disconcerting to the panel was the proliferation of healthcare rankings available on the Internet. "Ranking hospitals and healthcare providers is an incredibly difficult task with complex methodology. Although many of the organizations that issue rankings and report cards don't provide an explanation of their ranking methods, those that do often put a strong emphasis on financial performance rather than the elements of healthcare that are of most concern to patients and physicians," Krumholz says.
The panelists were divided into three work groups to look at ways to measure quality of care for the three most common types of cardiovascular disease: acute myocardial infarction (heart attack) congestive heart failure and stroke.
All three work groups determined that hospitals and physicians can achieve excellence in patient care by following the practice guidelines already set forth by the American Heart Association and the American College of Cardiology. "Physicians and other healthcare providers can ask themselves whether patients are getting what they are supposed to be getting in terms of medication and procedures, and are they getting it in a timely manner, according to existing guidelines," says Krumholz.
"The medical community has reached the point where it needs to accept greater accountability for the quality of care it delivers," he says. "We believe it is critical to begin this process by generating the information needed to measure the quality of care," he says.
The second scientific forum will meet in April 2000 to focus on quality and performance measures for specific cardiovascular procedures, such as bypass surgery.
In addition to the report in the March 28 issue of Circulation, a detailed paper on the findings of the congestive heart failure work group can be found in the online edition of the journal. Expanded reports from the other two work groups will be published online in the coming months.
Other organizations involved in the scientific forum were The Veterans Affairs Health System, The Robert Wood Johnson Foundation and Bristol-Meyers Squibb.
American Heart Association guidelines can be found on the Internet at http://www.americanheart.org.