In the United States, comparative rankings of hospitals based on the quality of their cardiovascular (CV) care are easily available online and in the mainstream media. In Canada, this information is almost entirely unavailable, but a new joint initiative of the Canadian Cardiovascular Society (CCS) and the Canadian Institute for Health Information (CIHI) is working to change that.
Given that the national cost of CV care is projected to reach $28.3 billion by 2020, there are good reasons to track standardized quality indicators across the country: improving quality of care, reducing medical errors and minimizing regional disparities are among them.
As reported in a CCC workshop on the need for national quality indicators, many different organizations already measure CV care within the provinces. The problem is that the efforts are often not coordinated, the data are not compatible and information is not shared.
CCS has formed working groups to identify appropriate quality indicators for major subspecialty areas. Finalized lists of indicators to be tracked and the current ability to capture data for each was presented by the following groups: cardiac surgery, percutaneous coronary intervention (PCI), heart failure, atrial fibrillation, cardiac rehabilitation, and transcatheter aortic valve insertion (TAVI).
CIHI will be the final collection, analysis and reporting body for the data. Unfortunately, many of the chosen indicators were rated poorly for the current state of data collection. One of CIHI’s roles is to work with stakeholders to extend coverage and access to data sources. In some cases, this will involve expanding the data elements that are routinely collected at the patient record level.
Another current limitation is that much of CIHI’s data is limited to in-hospital care. They can’t track non-admitted or patient visits managed in the emergency room at this time. They are also unable to track outcomes in terms of out-of-hospital mortality.
Another contentious issue is reporting. Who should have access and at what level of detail? As presenters indicated, there is a lot of fear and apprehension around public reporting of hospital and physician-specific data. Interestingly, a straw poll of the audience that consisted largely of doctors, nurses, administrators and heath information professionals was heavily in favour of publicly reporting hospital results.
CCS intends to make the national quality indicators workshop an annual session at the Congress.