CCORT/CCS quality indicators for acute myocardial infarction care.
BACKGROUND
Although quality indicators for the care of acute myocardial infarction (AMI) patients have been described for other countries, there are none specifically designed for the Canadian health care system. The authors' goal was to develop a set of Canadian quality indicators for AMI care.


METHODS
A literature review identified existing quality indicators for AMI care. A list of potential indicators was assessed by a nine-member panel of clinicians from a variety of disciplines using a modified-Delphi panel process. After an initial round of rating the potential indicators, a series of indicators was identified for a second round of discussion at a national meeting. Further refinement of indicators occurred following a teleconference and review by external reviewers.


RESULTS
To identify an AMI cohort, case definition criteria were developed, using a hospital discharge diagnosis for AMI of International Classification of Diseases-Ninth revision (ICD-9) code 410.x. Thirty-seven indicators for AMI care were established. Pharmacological process of care indicators included administration of acetylsalicylic acid, beta-blockers, angiotensin-converting enzyme inhibitors, thrombolytics and statins. Mortality and readmissions for AMI, unstable angina and congestive heart failure were recommended as outcome indicators. Nonpharmacological indicators included median length of stay in the emergency department, and median waiting times for cardiac catheterization, percutaneous coronary intervention and/or coronary artery bypass graft surgery.


CONCLUSIONS
A set of Canadian quality indicators for the care of AMI patients has been established. It is anticipated that these indicators will be useful to clinicians and researchers who want to measure and improve the quality of AMI patient care in Canada.
Tran
Chau T T
CT
Institute for Clinical Evaluative Sciences, Toronto, Ontario.
Lee
Douglas S
DS
Flintoft
Virginia F
VF
Higginson
Lyall
L
Grant
F Curry
FC
Tu
Jack V
JV
Cox
Jafna
J
Holder
Doug
D
Jackevicius
Cynthia
C
Pilote
Louise
L
Tanser
Paul
P
Thompson
Christopher
C
Tsoi
Edward
E
Warnica
Wayne
W
Wielgosz
Andreas
A
D000553:Ambulatory Care; D019985:Benchmarking; D002170:Canada; D002317:Cardiovascular Agents / Q000592:standards / Q000627:therapeutic use; D019983:Guideline Adherence; D006801:Humans; D038801:International Classification of Diseases; D007902:Length of Stay; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D019984:Quality Indicators, Health Care / Q000592:standards*
D002317:Cardiovascular Agents