Year: 2014
Type: article
Abstract: In the first decade of the 21st century, the activities in the American cardiac catheterization laboratories underwent significant changes. From mostly cardiac diagnostic catheterization and basic angioplasty and stenting the procedures became more complex, diverse, involving the peripheral vascular, carotid, renal, aortic, or venous systems. As interventional cardiology is still a young and hyperdynamic playfield, new devices have been constantly developed and new procedures were invented. While these new equipment improved the success, safety of procedures and outcome of patients, they also carried a heavy price tag. As these changes occurred during federal budget cutbacks and recession, the rise in health care spending became an epicenter of attention and experienced extraordinary scrutiny under the media microscope. Armed with data of increase in cost, the American society is more vocal in demanding an improved symptom-free quality of life combined with proven increase in life expectancy. How did the Society of Cardiovascular Angiography (SCAI) and the American College of Cardiology (ACC) guide the American interventional cardiology community through these political and economics pressure? How did interventional cardiologists challenge themselves with the advent of new changes in technology, social, and economic landscape? First, the most important and effective strategy of SCAI is to promote a new culture of outcome-based improvement, change, and innovation to the whole interventional cardiology community. This new culture promotes excellence by adhering to new standards of care, improving patient outcome by practicing evidence-based medicine, and bringing about uniformity in the performance of various invasive/interventional procedures. Latif et al1 discuss in more details the implementation of different quality initiatives developed by SCAI in this issue of the Chinese Medical Journal. The second best strategy of SCAI is to change or improve the structure of the system (hardware and software) in order to change the outcomes. This is best evidenced by the discontinuation of the paper charts and use of electronic format for medical records (EMR). The past and present data on patients are always legible (no handwriting), available to the healthcare givers (HCG) anywhere through the Internet (so there is no discontinuation of care), translating into comprehensive and cost effective patient care (no duplication of testings), etc. At a stroke of a fingertip, data mining from the EMR can produce comprehensive information, evaluation, and comparison of care among various patients groups. Comparison charts of a same group of patients through different time frame, between patients from one hospital to the patients of other hospitals of same size, level of severity, regions, etc. can be generated. The information would help the physicians, leadership team of each hospital, clinic, or policy makers to make improvements at every level for better patient care. The third strategy is to make the current quality monitoring system more effective. As in a self-policing management strategy in the US healthcare system, all medical facilities are organized with an internal process. The quality assurance (QA) committee at each facility is entrusted with this role. If the function of the in-house QA committee is weak or incompetent, the organization such as the Accreditation of Cardiovascular Excellence can evaluate the services and identify areas that would benefit from further improvement.2 In order to improve further the appropriateness of selection for invasive diagnostic and interventional procedures, SCAI with the cooperation with many other US professional societies, released the Appropriate Use Criteria (AUC) in order to guide the US interventional cardiologists in selection of these procedures. The methodology and applications of AUC are discussed in details by Chen et al3 in an article in this issue of the Chinese Medical Journal. Fourth, SCAI introduced the concept of “quality champion” to improve overall outcomes by incorporating evidence-based medicine and to have uniformity of performances on a local scale. SCAI also invested in the future of the interventional community through a partnership with ACC and the Cardiovascular Research Foundation (CRF) to develop the Emerging Leader Mentorship Program to identify the best and brightest minds and develop them into leaders not only for a local and national setting but also for an international stage. SCAI also launched a training program for the directors of cardiac catheterization laboratories (CCL) in order to educate them how to manage successfully a CCL. This question is discussed in details by Daggubati et al4 in an article in this issue of the Chinese Medical Journal. These quality initiatives of SCAI are addressed in the 4 articles of this issue and represent an American model for quality and excellence that may hopefully be used successfully in any other country as well.
Source: Chinese Medical Journal
Authors: James Nguyen, Faisal Latif, Thach Nguyen, Theodore A. Bass
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,000
OpenAlex ID: W2443523255