Top Things to Know: Defining Quality in Cardiovascular Imaging
Published: December 14, 2017
- Previous efforts to evaluate the quality of CV imaging have focused on structural and process measures of quality as assessed by accreditation standards and patient selection through the development of appropriateness criteria.
- Defining how to measure quality in CV imaging is essential because imaging remains a widely used and potentially costly resource affecting all aspects of CV patient care.
- The purpose of this scientific statement is to refine the definition of quality in CV imaging and to propose novel methodological approaches to inform the demonstration of quality in imaging in future clinical trials and registries.
- For a CV imaging procedure, defining quality is complex because it relates to multiple dynamic variables which include: appropriateness of the initial referral decision; the equipment used or available; the use of standardized imaging protocols and reporting; the accuracy of image interpretation; and the likelihood that imaging results will be directly tied to subsequent patient management.
- This scientific statement reviews several key dimensions of quality in CV imaging: safety, appropriateness, patient-centeredness, timeliness, effectiveness, equitability, and efficiency.
- Each of the quality indicators listed here provide a framework for defining quality of CV imaging.
- This scientific statement proposes how the indicators listed here can form the basis for future clinical research. Areas explored include: pragmatism in CV imaging research (using a pragmatic trial approach); embedded randomized trials; and optimal follow-up and episode of care (target follow-up that resembles the episode of care).
- This paper discusses patient-centered outcomes and optimal CV imaging endpoints. Key components of patient-centered outcomes research in CV imaging include: methodological considerations for randomized trials and observational research; effectiveness; meaningful effect size; heterogeneity; and patient-scientist collaborations.
- This statement provides a broad-based discussion of quality in CV imaging, with the definition for quality based on the IOMs key indicators.
- This statement may serve as a foundation for integrating each of the quality indicators for establishing designations of quality laboratory practices and as standards for value-based payment reform for imaging procedures.
Citation
Shaw LJ, Blankstein R, Jacobs JE, Leipsic JA, Kwong RY, Taqueti VR, Beanlands RSB, Mieres JH, Flamm SD, Gerber TC, Spertus J, Di Carli MF; on behalf of the American Heart Association Cardiovascular Imaging and Intervention Subcommittee of the Council on Clinical Cardiology; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular and Stroke Nursing; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; and Council on Quality of Care and Outcomes Research. Defining quality in cardiovascular imaging: a scientific statement from the American Heart Association. Circ Cardiovasc Imaging. 2017;10:e000017. DOI: 10.1161/HCI.0000000000000017.