Abstract
Quality indicators for adult congenital heart disease (ACHD) were recently published due to a lack of consensus regarding delivery of care to adults with congenital heart disease (CHD). The objective of this study was to examine adherence to quality indicators for the care of patients with tetralogy of Fallot. Adults with tetralogy of Fallot seen in outpatient cardiology clinics at a tertiary care facility between July 2014 and June 2015 were included, and electronic medical records for each visit were reviewed. Completion rates for eight proposed quality indicator metrics were recorded and results for ACHD and non-ACHD cardiologists were compared. A total of 96 eligible patients completed 179 cardiology visits (134 ACHD and 45 non-ACHD). The quality indicator completion rates were over 80% for 7 of the 8 indicators. Metric 5 (cardiac magnetic resonance imaging every five years) had the lowest completion rate at 38.7%. Compared to non-ACHD cardiologists, ACHD cardiologists had higher completion rates for QRS assessment (88.1% vs. 75.6%, p = 0.04), echocardiogram by CHD expert (97.8% vs. 80.0%, p < 0.001), and infective endocarditis counseling (95.9% vs. 77.4%, p = 0.001). In this single center study, there was a wide range of quality indicator completion rates for tetralogy of Fallot. Routine cardiac MRI by an expert in CHD was identified as an area for improvement. There were significant differences in quality indicator completion between ACHD and non-ACHD cardiologists.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Warnes CA et al (2008) ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 52(23):e143–e263
Adult Congenital Heart Disease Policies (2017). http://www.abim.org/certification/policies/internal-medicine-subspecialty-policies/adult-congenital-heart-disease.aspx. 12 Nov 2017
Baumgartner H et al (2010) ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 31(23):2915–2957
Silversides CK et al. (2010) Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: complex congenital cardiac lesions. Can J Cardiol 26(3): e98–e117
Spertus JA et al (2005) American College of Cardiology and American Heart Association methodology for the selection and creation of performance measures for quantifying the quality of cardiovascular care. Circulation 111(13):1703–1712
Gurvitz M et al (2013) Building quality indicators to improve care for adults with congenital heart disease. J Am Coll Cardiol 62(23):2244–2253
Brook RH (1994) Clinical practice guideline development: methodology perspectives
Brook RH, McGlynn EA, Cleary PD (1996) Quality of health care. Part 2: measuring quality of care. N Engl J Med 335(13):966–970
Beller GA et al (2002) ACC revised recommendations for training in adult cardiovascular medicine. Core Cardiology Training II (COCATS 2). (Revision of the 1995 COCATS training statement). J Am Coll Cardiol 39(7):1242–1246
Kanal E et al (2007) ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol 188(6):1447–1474
Valente AM et al (2014) Multimodality imaging guidelines for patients with repaired tetralogy of fallot: a report from the AmericanSsociety of Echocardiography: developed in collaboration with the Society for Cardiovascular Magnetic Resonance and the Society for Pediatric Radiology. J Am Soc Echocardiogr 27(2):111–141
Broberg C et al (2015) Accuracy of administrative data for detection and categorization of adult congenital heart disease patients from an electronic medical record. Pediatr Cardiol 36(4):719–725
Strickland MJ et al (2008) The importance of nomenclature for congenital cardiac disease: implications for research and evaluation. Cardiol Young 18(Suppl 2):92–100
Hye RJ et al (2014) Leveraging the electronic medical record to implement an abdominal aortic aneurysm screening program. J Vasc Surg 59(6):1535–1542
Minard JP et al (2014) Development and implementation of an electronic asthma record for primary care: integrating guidelines into practice. J Asthma 51(1):58–68
Acknowledgements
We would like to acknowledge Big Hearts to Little Hearts and the Duffine Family Foundation for their generous support of the Philadelphia Adult Congenital Heart Center.
Author information
Authors and Affiliations
Contributions
ST—Concept/Design, data collection, data analysis/interpretation, drafting article. LG—Concept/Design, data collection, approval of the article. YK—Concept/Design, critical revision of article, approval of the article.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to disclose.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Rights and permissions
About this article
Cite this article
Tsaur, S., Gleason, L. & Kim, Y. Quality Indicator Completion Rates for Adults with Tetralogy of Fallot. Pediatr Cardiol 39, 1700–1706 (2018). https://doi.org/10.1007/s00246-018-1954-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-018-1954-0