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Improving Guideline Compliance in Australia With a National Percutaneous Coronary Intervention Outcomes Registry
David Eccleston1, Mark Horrigan2, Tony Rafter3
1GenesisCare, Sydney, NSW, Australia, Department of Medicine, University of Melbourne, Melbourne, Vic, Australia, Cardiology Department, Royal Melbourne Hospital, Melbourne, Vic, Australia.
Insights
Implementing a national registry for percutaneous coronary intervention (PCI) data improved guideline medication compliance. This quality improvement initiative enhanced patient care by identifying and addressing gaps in secondary prevention therapies after PCI.
Area of Science:
- Cardiology
- Health Services Research
- Clinical Quality Improvement
Background:
- Secondary prevention after percutaneous coronary intervention (PCI) faces adherence gaps to guideline therapies like statins and dual anti-platelet therapy.
- Contemporary PCI necessitates robust data collection for auditing performance and safety indices.
- Genesis HeartCare, a large Australian cardiology collaboration, aimed to improve outcomes via data measurement and reporting.
Purpose of the Study:
- To evaluate if measuring and reporting data within a national clinical quality registry improves patient outcomes after PCI.
- To benchmark key performance and safety indices against aggregated data and international standards.
Main Methods:
- Prospective data collection of clinical, procedural, medication, and outcomes for 6720 PCI patients across 10 private Australian hospitals.
- Real-time benchmarking using the Genesis Cardiovascular Outcomes Registry (GCOR-PCI).
- Reporting key performance outcomes to individual sites for quality improvement.
Main Results:
- Early data revealed practice patterns linked to lower statin use, prompting practice changes.
- Significant improvements observed in statin therapy rates at discharge (92.1% to 94.4%) and 12 months (87.0% to 92.2%).
- Improvement in 12-month antiplatelet therapy rates (90.7% to 94.3%) was also noted.
Conclusions:
- A large-scale collaborative clinical quality registry can serve as a platform for quality improvement initiatives.
- Establishing the GCOR-PCI registry enhanced patient care by identifying and monitoring gaps in guideline therapy delivery.
- The registry effectively drove practice change and improved adherence to secondary prevention strategies post-PCI.
Background:
Secondary prevention strategies after percutaneous coronary intervention (PCI) include statins and dual anti-platelet therapy, however there are significant gaps between guidelines and practice. Contemporary PCI practice requires comprehensive data collection to allow dynamic auditing and benchmarking of key performance and safety indices. Genesis HeartCare is Australia's largest collaborative venture of cardiologists, practising at over 40 public and private hospitals. We hypothesised that measurement and local reporting of data would improve patient outcomes through improving compliance with guideline therapies.
Methods:
Real-time benchmarking via a national clinical quality and outcomes register, the Genesis Cardiovascular Outcomes Registry (GCOR-PCI). GCOR-PCI prospectively collected clinical, procedural, medication and outcomes data for 6720 consecutive patients undergoing PCI from 10 private hospitals across Australia. Key performance outcomes benchmarked against the aggregated study cohort and international standards were reported to individual sites. The main outcome measure was compliance with guideline medications (statins, anti-platelet agents).
Results:
Early data identified specific practice patterns associated with lower rates of statin therapy post-PCI, which led to changes in practice. Between the first and latest year of data collection there was significant improvement in the rates of statin therapy at discharge (92.1 vs. 94.4% p<0.03) and 12 months post-PCI (87.0 vs. 92.2% p<0.001) and of antiplatelet therapy at 12 months (90.7 vs. 94.3% p<0.001).
Conclusions:
This large-scale collaboration provides a platform for the development of quality improvement initiatives. Establishment of this clinical quality registry improved patient care by identifying and monitoring gaps in delivery of appropriate therapies, driving key practice change.