QualityPath™ Elective Cardiac Catheterization (Cath) and Elective Angioplasty (PCI) Evaluation Criteria – DRAFT
QualityPath™ PCI PHYSICIAN AND FACILITY EVALUATION CRITERIA
Criteria
Registry Participation –
Facility
Rationale
Facilities need timely, accurate and
clinically relevant information to
improve patient outcomes,
determine appropriate care, engage
patients in decision-making and be
good stewards of scarce resources.
Definition/Action
To be eligible for QualityPath™
designation, a facility must
participate in the American College
of Cardiology Cath/PCI Registry
https://www.ncdr.com/webnedr/ca
thpci/
Registry Participation Physician
Physicians need timely, accurate
and clinically relevant information
to improve patient outcomes,
determine appropriate care, engage
patients in decision-making and be
good stewards of scarce resources.
To be eligible for QualityPath™
designation, a physician must
participate in the American College
of Cardiology Cath/PCI Registry
https://www.ncdr.com/webnedr/ca
thpci/
Transparency - Facility
Consumers have a right to know
about differences in cost and
quality between health care
facilities, physicians and other
clinicians; and a responsibility to
educate themselves about these
differences as part of making health
care decisions.
To be eligible for QualityPath™
designation the following results for
all PCI (inpatient and outpatient)
procedures at the facility must be
reported to QualityPath™ and the
facility must participate in all
available CMS Hospital Compare
reporting
687289582

Cath/PCI case volume for each
of the past two calendar years

Diagnostic catheterization case
Meets
Provide NCDR Facility Dashboard to
QualityPath™ to confirm registry
participation and facilitate
collection of metrics listed below
under transparency.
Briefly describe how facility uses
registry data to work together with
physicians to improve quality.
Provide NCDR Physician Dashboard
to QualityPath™ to confirm registry
participation and facilitate
collection of metrics listed below
under transparency.
Results available to QualityPath™
Applicable results publicly reported
through HospitalCompare
Results at or better than average
compared to NCDR national
averages
1
Criteria
687289582
Rationale
Definition/Action
volume for each of the past two
calendar years

Proportion of PCI patients with
death, emergency CABG,
stroke, or repeat target vessel
revascularization

Proportion of PCI patients with
post-procedure MI

Proportion of PCI patients with
acute kidney injury

Proportion with a CAD
symptom and activity
assessment

Proportion who participated in
cardiac rehab

Proportion with no
complications (no death, no
emergency CABG, no stroke, no
repeat target vessel
revascularization, no postprocedure MI and no acute
kidney injury) and CAD
symptom and activity
assessment and participated in
cardiac rehab (meeting all give
of the above standards)
Meets
2
Criteria
Transparency Physician
687289582
Rationale
Consumers have a right to know
about differences in cost and
quality between health care
facilities, physicians and other
clinicians; and a responsibility to
educate themselves about these
differences as part of making health
care decisions.
Definition/Action
 PCI in-hospital risk adjusted
mortality (all patients)

Elective PCI Appropriateness
rates (I/U/A) and proportion
unable to be scored for
appropriateness

PCI 30-day readmission

Additional measures as
available HospitalCompare
To be eligible for QualityPath™
designation the following results for
all PCI (inpatient and outpatient)
procedures by the physician must
be reported to QualityPath™ and
the physician must participate in all
available CMS Physician Compare
reporting

Cath/PCI case volume for each
of the past two calendar years

Diagnostic catheterization case
volume for each of the past two
calendar years

Proportion of PCI patients with
death, emergency CABG,
stroke, or repeat target vessel
revascularization
Meets
Results available to QualityPath™
Applicable results publicly available
through PhysicianCompare
Results at or better than average
compared to NCDR national
averages
3
Criteria
687289582
Rationale
Definition/Action

Proportion of PCI patients with
post-procedure MI

Proportion of PCI patients with
acute kidney injury

Proportion with a CAD
symptom and activity
assessment

Proportion who participated in
cardiac rehab

Proportion with no
complications (no death, no
emergency CABG, no stroke, no
repeat target vessel
revascularization, no postprocedure MI and no acute
kidney injury) and CAD
symptom and activity
assessment and participated in
cardiac rehab (meeting all give
of the above standards)

PCI in-hospital risk adjusted
mortality (all patients)

Elective PCI Appropriateness
rates (I/U/A) and proportion
unable to be scored for
appropriateness
Meets
4
Criteria
Rationale
Definition/Action

Transparency –
Affiliated/referring
primary care practice(s)
and cardiology practice
Standardize clinical
processes – Decision
support for ordering
diagnostic cardiac
imaging tests
Managing cardiovascular risk
factors well in patients with known
cardiovascular disease decreases
their likelihood of suffering serious
complications.
Decision support for diagnostic
imaging provides immediate help
determining the best test based on
a patient’s indication and available
evidence and best practice. It helps
physicians order the right test the
first time, saving the cost of
unnecessary or low utility tests.
http://www.medcurrent.com/JACR
_Jan_2011__Effectiveness_of_Clinical_Decision
_Support_in_Controlling_Inappropr
iate_Imaging.pdf
687289582
Meets
Additional measures as
available PhysicianCompare
To be eligible for QualityPath™
designation affiliated/referring
primary care practices and the
cardiology practice must participate
in public reporting by clinic site of:

Optimal Diabetes Care (A1c,
LDL, and BP control, aspirin use,
not using tobacco)

Optimal Cardiovascular Disease
(CVD) Care (LDL and BP control,
aspirin use, not using tobacco)
To be eligible for QualityPath™
designation Decision Support for
ordering cardiac diagnostic imaging
tests must be used consistently by
cardiology practice and
affiliated/referring primary care
practice(s). e.g. FOCUS
Results must be tracked and
reported by physician, by practice,
and by facility
Results publicly available through
QualityPath™ or other designated
venue
Results at or better than average
Describe the diagnostic imaging
decision support process
Specific Decision support tool used
provided to QualityPath™
Results provided to QualityPath™
by physician, by group practice and
by facility
5
Criteria
Standardize clinical
processes –
Appropriateness of
diagnostic
catheterization
Rationale
Appropriate use criteria (AUC) for
diagnostic catheterization insure
that patients undergoing diagnostic
catheterization are likely to benefit
from the procedure.
Definition/Action
To be eligible for QualityPath™
designation the cardiology practice
must have a process in place for
determining and measuring the
appropriateness of diagnostic
catheterization using the 2012 ACC
Appropriate Use Criteria for
Diagnostic Catheterization available
at:
http://content.onlinejacc.org/articl
e.aspx?articleid=1182705
Meets
Describe the appropriate use
process
Results provided to QualityPath™
by physician, by group practice and
by facility
Proportion of appropriate,
uncertain and inappropriate
diagnostic catheterizations must be
tracked and reported by physician,
by practice, and by facility.
Standardize clinical
processes - Patients
actively engaged in
shared decision
making using a high
quality decision aid
Shared decision making ensures
that patients are informed of all
options for treating their condition
prior to the procedure, that they
understand the risks and benefits of
each option, and that they want to
proceed with a PCI.
To be eligible for QualityPath™
designation the cardiology practice
must engage all patients in shared
decision making process using a
high quality decision aid that
includes optimal medical therapy as
one treatment option.
Proportion of elective cath and
elective PCI patients participating in
shared decision making must be
tracked and reported by physician,
by practice, and by facility
Describe the shared decision
making process
Decision aid instrument provided to
QualityPath™
Results provided to QualityPath™
by physician, by group practice and
by facility
Multiple decision aid options are
687289582
6
Criteria
Rationale
Definition/Action
available at:
http://decisionaid.ohri.ca/AZinvent.
php
Meets
Decision aid for medical treatment
vs. stenting for angina available at:
http://www.optiongrid.org/resourc
es/angina_grid_usa.pdf
Standardize Clinical
Processes - Quality of
patient decision
making assessed using
a standardized
instrument
Assessing the quality of shared
decision making prior to PCI helps
identify gaps in patient’s
understanding and the extent to
which the patient was actively
engaged in deciding to have PCI.
To be eligible for QualityPath™
designation the quality of patient
decision making must be assessed
prior to cath and PCI, for all
patients, using a standardized
instrument
Describe the process for assessing
the quality of shared decision
making
Proportion of Cath and PCI patients
completing assessment of decision
quality must be tracked and
reported by physician, by practice,
and by facility
Results provided to QualityPath™
by physician, by group practice and
by facility
Instrument used to assess decision
quality provided to QualityPath™
Decision Quality assessment tools
are available at no cost:
http://www.massgeneral.org/decisi
onsciences/assets/pdfs/CAD_DQI_S
V.pdf
Standardize Clinical
Processes –
Conversation about
future care needs
687289582
Spelling out what kind of medical
care we want if we are too ill or
hurt to express our wishes is a way
of telling our wishes to family,
To be eligible for QualityPath™
Results available to QualityPath™
designation there must be a process
in place to ensure a conversation
about future care needs is
7
Criteria
Rationale
friends, and health care
professionals to avoid confusion
later on.
Definition/Action
documented in an Advanced
Directive
Meets
Proportion of patients with
conversation documented in an
Advanced Directive is tracked
Disclose potential
conflicts of interest –
Facility
Disclose potential
conflicts of interest Physician
687289582
Full disclosure of potential conflicts
of interest helps ensure treatment
decisions are not influenced by
commercial interests
Full disclosure of potential conflicts
of interest helps ensure treatment
decisions are not influenced by
commercial interests
To be eligible for QualityPath™
designation the facility must have a
policy on industry conflict of
interest in place that includes full
disclosure to patients
Policy provided to QualityPath™
All direct and indirect industry
payments must be tracked by
facility
Direct and Indirect payments
provided to QualityPath™ annually
To be eligible for QualityPath™
designation the cardiology practice
must have a policy on industry
conflict of interest in place that
includes full disclosure to patients
Policy provided to QualityPath™
All direct and indirect industry
payments must be tracked by
individual physician
Direct and Indirect payments
provided to QualityPath™ annually
Example of patient disclosure (e.g.
hard copy report or website link)
provided to QualityPath™
Example of patient disclosure (e.g.
hard copy report or website link)
provided to QualityPath™
8