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Quality Indicator Completion Rates for Adults with Tetralogy of Fallot

Stephen Tsaur1,2, Lacey Gleason3,4, Yuli Kim3,4

  • 1Philadelphia Adult Congenital Heart Center, Philadelphia, PA, USA. Stephen.tsaur@gmail.com.

Pediatric Cardiology
|August 20, 2018
PubMed

Insights

Quality indicators for adult congenital heart disease (ACHD) care show high adherence, but cardiac MRI completion needs improvement. ACHD specialists demonstrated better adherence to several key quality metrics for tetralogy of Fallot patients.

Area of Science:

  • Cardiology
  • Adult Congenital Heart Disease (ACHD)
  • Public Health

Background:

  • Lack of consensus on care delivery for adults with congenital heart disease (CHD) led to the development of quality indicators.
  • Tetralogy of Fallot is a common complex congenital heart disease requiring specialized lifelong care.

Purpose of the Study:

  • To evaluate adherence to newly published quality indicators for the care of adult patients with tetralogy of Fallot.
  • To compare the completion rates of these indicators between adult congenital heart disease (ACHD) specialists and non-ACHD cardiologists.

Main Methods:

  • Retrospective review of electronic medical records for adult tetralogy of Fallot patients seen between July 2014 and June 2015.
  • Analysis of completion rates for eight proposed quality indicator metrics.
  • Statistical comparison of adherence between ACHD and non-ACHD cardiologists.

Main Results:

  • Overall adherence was high, with 7 out of 8 indicators exceeding 80% completion.
  • Cardiac magnetic resonance imaging (MRI) every five years (Metric 5) had the lowest completion rate (38.7%).
  • ACHD cardiologists showed significantly higher adherence for QRS assessment, echocardiograms by CHD experts, and infective endocarditis counseling compared to non-ACHD cardiologists.

Conclusions:

  • While overall adherence to quality indicators for tetralogy of Fallot care is good, routine cardiac MRI by CHD experts requires improvement.
  • Specialized ACHD care is associated with better adherence to specific quality metrics.
  • Further efforts are needed to optimize adherence to all quality indicators, particularly advanced imaging protocols.

Keywords:
Adult congenital heart diseaseQuality improvementQuality indicatorsTetralogy of Fallot

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