CMAJ • October 21, 2008; 179 (9). doi:10.1503/cmaj.080749.
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Review

Indicators of quality of care for patients with acute myocardial infarction

Jack V. Tu, MD PhD, Laila Khalid, MD, Linda R. Donovan, BScN MBA, Dennis T. Ko, MD MSc for the Canadian Cardiovascular Outcomes Research Team / Canadian Cardiovascular Society Acute Myocardial Infarction Quality Indicator Panel

From the Institute for Clinical Evaluative Sciences (Tu, Khalid, Donovan, Ko), Toronto, Ont.; the Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre (Tu, Ko), Toronto, Ont.; and the Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto (Tu, Ko), Toronto, Ont. Members of the panel appear at the end of the article.

Correspondence to: Dr. Jack V. Tu, Rm. G-106, Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto ON M4N 3M5; fax 416 480-6048; tu{at}ices.on.ca

Abstract

Background: There is a wide practice gap between optimal and actual care for patients with acute myocardial infarction in hospitals around the world. We undertook this initiative to develop an updated set of evidence-based indicators to measure and improve the quality of care for this patient population.

Methods: A 12-member expert panel was convened in 2007 to develop an updated set of quality indicators for acute myocardial infarction. The panel identified a list of potential indicators after reviewing the scientific literature, clinical practice guidelines and other published quality indicators. To develop the new list of indicators, the panel rated each potential indicator on 4 dimensions (reliability, validity, feasibility and usefulness in improving patient outcomes) and discussed the top-ranked quality indicators at a consensus meeting.

Results: Consensus was reached on 38 quality indicators: 17 that would be measurable using chart-abstracted data and 21 that would be measurable using administrative data. Of the 17 chart-review indicators, 13 address pharmacologic and nonpharmacologic care delivered to patients in hospital. In-hospital mortality was recommended as a key outcome indicator. Three system indicators were recommended to measure the collaborative responsiveness of the health care system from the call for help to intervention. It was recommended that hospitals strive for a minimum target benchmark of 90% or greater on process-of-care indicators.

Interpretation: Implementation of strategies by clinicians and hospitals to meet target benchmarks on these quality indicators could save the lives of many individuals with acute myocardial infarction.


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J. Chen MD MPH and S.-L. T. Normand PhD
Myocardial infarction and quality of care
Can. Med. Assoc. J., October 21, 2008; 179(9): 875 - 876.
[Full Text] [PDF]

eLetters:

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Statins post MI not optimal care
Eddie Vos
CMAJ, 23 Oct 2008 [Full text]
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CMAJ, 6 Nov 2008 [Full text]
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CMAJ, 18 Nov 2008 [Full text]
Quality reperfusion remains a matter of time
Robert C. Welsh
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