Abstract 11296: Practice Level Variation in Cardiac Performance Measure Compliance: Insights from the American College of Cardiology's Practice Innovation and Clinical Excellence (PINNACLE) Program
Background: While the American College of Cardiology's Practice Innovation And Clinical Excellence (PINNACLE) Program has reported rates of compliance for performance measures for coronary artery disease (CAD), heart failure (HF), and atrial fibrillation, the extent of practice-level variation in compliance rates for performance measures is unknown.
Methods: PINNACLE is the first, national, office-based quality improvement program of cardiac patients designed, in part, to report outpatient performance measure compliance. Using data from 7/08 through 12/09, we examined the extent of site-level variation in compliance rates for 7 performance measures related to medication treatment for CAD, HF, and atrial fibrillation. For each performance measure, we quantified the median rate ratio (RR), which can be interpreted as the likelihood that 2 ‘identical’ patients randomly treated at 2 different practices would have receive been treated with a specific performance measure. In general, median RRs above 1.2 indicate at least moderate practice variation.
Results: There were 136,204 unique patients enrolled from 29 U.S. practices. A moderate degree of practice-level variation in compliance was observed for 4 of the 7 performance measures (Table). For instance, practice rates for lipid lowering drugs in patients with CAD ranged from 40% to 100%, with a median RR of 1.23. In contrast, there was marked variation in use of warfarin therapy among patients with atrial fibrillation at high risk for stroke (CHADS2 score of ≥2), with the range of practice rates from 9% to 98%, and a median RR of 1.71.
Conclusions: Within the PINNACLE registry, we found moderate variation in compliance among practices for several performance measures related to medication treatment and marked variation in warfarin use in high-risk patients with atrial fibrillation. For each performance measure, the presence of variation suggests an opportunity to improve the quality of outpatient cardiac care.
- © 2010 by American Heart Association, Inc.