title: Cardiac performance measure compliance in outpatients: the American College of Cardiology and National Cardiovascular Data Registry's PINNACLE (Practice Innovation And Clinical Excellence) program.
abstract: OBJECTIVE
  We examined compliance with performance measures for 14,464 patients enrolled from July 2008 through June 2009 into the American College of Cardiology's PINNACLE (Practice Innovation And Clinical Excellence) program to provide initial insights into the quality of outpatient cardiac care.
  
  
  BACKGROUND
  Little is known about the quality of care of outpatients with coronary artery disease (CAD), heart failure, and atrial fibrillation, and whether sex and racial disparities exist in the treatment of outpatients.
  
  
  METHODS
  The PINNACLE program is the first, national, prospective office-based quality improvement program of cardiac patients designed, in part, to capture, report, and improve outpatient performance measure compliance. We examined the proportion of patients whose care was compliant with established American College of Cardiology, American Heart Association, and American Medical Association-Physician Consortium for Performance Improvement (ACC/AHA/PCPI) performance measures for CAD, heart failure, and atrial fibrillation.
  
  
  RESULTS
  There were 14,464 unique patients enrolled from 27 U.S. practices, accounting for 18,021 clinical visits. Of these, 8,132 (56.4%) had CAD, 5,012 (34.7%) had heart failure, and 2,786 (19.3%) had nonvalvular atrial fibrillation. Data from the PINNACLE program were feasibly collected for 24 of 25 ACC/AHA/PCPI performance measures. Compliance with performance measures ranged from being very low (e.g., 13.3% of CAD patients screened for diabetes mellitus) to very high (e.g., 96.7% of heart failure patients with blood pressure assessments), with moderate (70% to 90%) compliance observed for most performance measures. For 3 performance measures, there were small differences in compliance rates by race or sex.
  
  
  CONCLUSIONS
  For more than 14,000 patients enrolled from 27 practices in the outpatient PINNACLE program, we found that compliance with performance measures was variable, even after accounting for exclusion criteria, suggesting an important opportunity to improve the quality of outpatient care.
authors.affiliation: Mid America Heart Institute, Kansas City, Missouri 64111, USA. pchan@cc-pc.com
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
authors.forename: William J
authors.initials: WJ
authors.lastname: Oetgen
authors.forename: Donna
authors.initials: D
authors.lastname: Buchanan
authors.forename: Kristi
authors.initials: K
authors.lastname: Mitchell
authors.forename: Fran F
authors.initials: FF
authors.lastname: Fiocchi
authors.forename: Fengming
authors.initials: F
authors.lastname: Tang
authors.forename: Philip G
authors.initials: PG
authors.lastname: Jones
authors.forename: Tracie
authors.initials: T
authors.lastname: Breeding
authors.forename: Duane
authors.initials: D
authors.lastname: Thrutchley
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000592:standards*; D001281:Atrial Fibrillation / Q000628:therapy*; D003327:Coronary Disease / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards; D014481:United States