Cardiac performance measure compliance in outpatients: the American College of Cardiology and National Cardiovascular Data Registry's PINNACLE (Practice Innovation And Clinical Excellence) program.
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.
Chan
Paul S
PS
Mid America Heart Institute, Kansas City, Missouri 64111, USA. pchan@cc-pc.com
Oetgen
William J
WJ
Buchanan
Donna
D
Mitchell
Kristi
K
Fiocchi
Fran F
FF
Tang
Fengming
F
Jones
Philip G
PG
Breeding
Tracie
T
Thrutchley
Duane
D
Rumsfeld
John S
JS
Spertus
John A
JA
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