ACCF/AHA Methodology for the Development of Quality Measures for Cardiovascular Technology: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures

• Published in: Journal of the American College of Cardiology 2011-09, Vol.58 (14), p.1517-1538
• Main Authors: BONOW, Robert O, DOUGLAS, Pamela S, MASOUDI, Frederick A, PETERSON, Eric D, TAYLOR, Allen J, BUXTON, Alfred E, COHEN, David J, CURTIS, Jeptha P, DELONG, Elizabeth, DROZDA, Joseph P, BRUCE FERGUSON, T, HEIDENREICH, Paul A, HENDEL, Robert C
• Format: Article
• Language: English
• Subjects: Advisory Committees - standards; American Heart Association; Biological and medical sciences; Cardiology; Cardiology - methods; Cardiology - standards; Cardiology. Vascular system; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - therapy; Disclosure; Endorsements; Evaluation Studies as Topic; Foundations - standards; Heart; Hospitals; Humans; Medical sciences; Quality of Health Care - standards; Task forces; Technological change; United States; Validity; Writing
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2011.07.007

Consistent with the growing national focus on healthcare quality, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have taken a leadership role over the past decade in developing measures of the quality of cardiovascular care by convening a joint ACCF/AHA Task Force on Performance Measures. The Task Force is charged with identifying the clinical topics appropriate for the development of performance measures and with assembling writing committees composed of clinical and methodological experts in collaboration with appropriate subspecialty societies. The Task Force has also created methodology documents that offer guidance in the development of process, outcome, composite, and efficiency measures. Cardiovascular performance measures using existing ACCF/AHA methodology are based on Class I or Class III guidelines recommendations, usually with Level A evidence. These performance measures, based on evidence-based ACCF/AHA guidelines, remain the most rigorous quality measures for both internal quality improvement and public reporting. However, many of the tools for diagnosis and treatment of cardiovascular disease involve advanced technologies, such as cardiac imaging, for which there are often no underlying guideline documents. Because these technologies affect the quality of cardiovascular care and also have the potential to contribute to cardiovascular health expenditures, there is a need for more critical assessment of the use of technology, including the development of quality and performance measures in areas in which guideline recommendations are absent. The evaluation of quality in the use of cardiovascular technologies requires consideration of multiple parameters that differ from other healthcare processes. The present document describes methodology for development of 2 new classes of quality measures in these situations, appropriate use measures and structure/safety measures. Appropriate use measures are based on specific indications, processes, or parameters of care for which high level of evidence data and Class I or Class III guideline recommendations may be lacking but are addressed in ACCF appropriate use criteria documents. Structure/safety measures represent measures developed to address structural aspects of the use of healthcare technology (e.g., laboratory accreditation, personnel training, and credentialing) or quality issues related to patient safety when there are neither guidelines recommenda