The Development and Feasibility Assessment of Canadian Quality Indicators for Atrial Fibrillation.
In 2010, the Canadian Cardiovascular Society embarked on an initiative to develop pan-Canadian quality indicators (QIs) and standardized data definitions with the ultimate goal of monitoring, comparing, and contrasting national cardiovascular care and its outcomes. One of the first working groups to be established was tasked with identifying and then defining a set of QIs for atrial fibrillation/flutter (AF/AFL). The Canadian Cardiovascular Society "Best Practices for Developing Cardiovascular Quality Indicators" methodology was used to develop an initial catalogue of 25 QIs intended to measure critical issues around access, process, and outcomes relating to AF/AFL management. This list was subsequently pared down to 5 QIs felt to have the greatest relative importance for quality assurance and measurability so as to facilitate early adoption. Three of these QIs were finally selected to assess the feasibility of their measurement using existing administrative datasets. These were the number of patients with a diagnosis of nonvalvular AF/AFL at high risk of stroke (75 years or older, or CHADS2≥ 2) receiving an oral anticoagulant, and the rates of stroke and major haemorrhage in patients with nonvalvular AF/AFL according to CHA2DS2-VASc score and anticoagulant use. Despite their clear importance in assessing AF/AFL care, none of these 3 QIs were found to be readily measurable across Canada using existing national datasets. Investment in new medical data infrastructure is required to facilitate regular monitoring of QIs to improve cardiovascular care.
Departments of Medicine and of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: jafna.cox@dal.ca.
Jafna L
JL
Cox
Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada.
Sulan
S
Dai
Health System Performance, Canadian Institute for Health Information, Ottawa, Ontario, Canada.
Yanyan
Y
Gong
Department of Medicine, Population Health Research Institute, McMaster University, London, Ontario, Canada.
Robert
R
McKelvie
Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
M Sean
MS
McMurtry
Cardiac Care Network of Ontario, Toronto, Ontario, Canada.
Garth H
GH
Oakes
Department of Medicine, London Heart Institute, University of Western Ontario, London, Ontario, Canada.
Allan
A
Skanes
Southlake Regional Health Centre, University of Toronto, Newmarket, Ontario, Canada.
Atul
A
Verma
Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
Stephen B
SB
Wilton
Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
D George
DG
Wyse
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D001282:Atrial Flutter / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D002170:Canada / Q000453:epidemiology; D016208:Databases, Factual / Q000592:standards; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000379:methods / Q000458:organization & administration; D010346:Patient Care Management / Q000458:organization & administration / Q000592:standards; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000592:standards / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control
D000925:Anticoagulants