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QUARTERLY FOCUS ISSUE: PREVENTION/OUTCOMES: CLINICAL RESEARCH: PERFORMANCE MEASURES IN OUTPATIENTS

Cardiac Performance Measure Compliance in Outpatients

The American College of Cardiology and National Cardiovascular Data Registry's PINNACLE (Practice Innovation And Clinical Excellence) Program

Paul S. Chan, MD, MS^_*,,_*, William J. Oetgen, MD, MBA, Donna Buchanan, PhD^_*, Kristi Mitchell, MPH, Fran F. Fiocchi, MPH, Fengming Tang, MS^_*, Philip G. Jones, MS^_*, Tracie Breeding, RN, BSN^_*, Duane Thrutchley, RN^_*, John S. Rumsfeld, MD, PhD^|| and John A. Spertus, MD, MPH^_*,

^_* Mid America Heart Institute, Kansas City, Missouri
University of Missouri, Kansas City, Missouri
Georgetown University School of Medicine, Washington, DC
American College of Cardiology, Washington, DC
^|| University of Colorado at Denver Medical Center and Denver VA Medical Center, Denver, Colorado

Manuscript received December 16, 2009; revised manuscript received March 4, 2010, accepted March 23, 2010.

^_* Reprint requests and correspondence: Dr. Paul S. Chan, Mid America Heart Institute, 5th Floor, 4401 Wornall Road, Kansas City, Missouri 64111 (Email: pchan{at}cc-pc.com).

Objectives: We examined compliance with performance measures for 14,464 patients enrolled from July 2008 through June 2009 into the American College of Cardiology's PINNACLE (Practice Innovation And Clinical Excellence) program to provide initial insights into the quality of outpatient cardiac care.

Background: Little is known about the quality of care of outpatients with coronary artery disease (CAD), heart failure, and atrial fibrillation, and whether sex and racial disparities exist in the treatment of outpatients.

Methods: The PINNACLE program is the first, national, prospective office-based quality improvement program of cardiac patients designed, in part, to capture, report, and improve outpatient performance measure compliance. We examined the proportion of patients whose care was compliant with established American College of Cardiology, American Heart Association, and American Medical Association-Physician Consortium for Performance Improvement (ACC/AHA/PCPI) performance measures for CAD, heart failure, and atrial fibrillation.

Results: There were 14,464 unique patients enrolled from 27 U.S. practices, accounting for 18,021 clinical visits. Of these, 8,132 (56.4%) had CAD, 5,012 (34.7%) had heart failure, and 2,786 (19.3%) had nonvalvular atrial fibrillation. Data from the PINNACLE program were feasibly collected for 24 of 25 ACC/AHA/PCPI performance measures. Compliance with performance measures ranged from being very low (e.g., 13.3% of CAD patients screened for diabetes mellitus) to very high (e.g., 96.7% of heart failure patients with blood pressure assessments), with moderate (70% to 90%) compliance observed for most performance measures. For 3 performance measures, there were small differences in compliance rates by race or sex.

Conclusions: For more than 14,000 patients enrolled from 27 practices in the outpatient PINNACLE program, we found that compliance with performance measures was variable, even after accounting for exclusion criteria, suggesting an important opportunity to improve the quality of outpatient care.

Key Words: performance measure • compliance • quality of care • outpatient

Abbreviations and Acronyms   ACC = American College of Cardiology   ACE-I = angiotensin-converting enzyme inhibitor   AHA = American Heart Association   ARB = angiotensin-receptor blocker   CAD = coronary artery disease   CI = confidence interval   DM = diabetes mellitus   PCPI = American Medical Asssociation-Physician Consortium for Performance Improvement   RR = relative rate

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