Following the 2015 Canadian Cardiovascular Congress (CCC), The Beat reported on a joint initiative of the Canadian Cardiovascular Society and the Canadian Institute for Health Information to develop and report on national quality indicators for cardiovascular care.
At this year’s Congress, the inaugural National Quality Report was released for transcatheter aortic valve insertion (TAVI) (pdf). Reporting was done on a regional basis consisting of Ontario, Québec, British Columbia and a grouping of Alberta/Manitoba/New Brunswick/Nova Scotia.
The results showed substantial variability across regions for some quality indicators:
Structural factors
- Documented recommendation for treatment by a heart team (80 to 100%)
- Wait times (90 to 145 days)
Process factors
- Documented risk score for each patient (26 to 93%)
- Evaluation of quality of life (not collected in Ontario and Québec)
Outcomes
- Mortality (not adjusted for risk) (30 days: 1.9 to 6.1%) (one year: 12.4 to 14%)
- In-hospital stroke (1.2 to 3.7%)
- All cause readmission (11.9 to 26.1%)
This initial release was intended, in part, as a proof of feasibility of the reporting process. Data quality issues identified in the report include the lack of data collection for some indicators across all centres and inconsistent definitions for certain indicators. Standardization of wait time measures was identified as a particular concern at the session.
As in the initial 2015 workshop, a poll of the audience showed that a majority support the eventual public reporting of quality results by identified hospital.