1 NOT a primary measure for PCI. Standard Applies only to hospital-based Acute Coronary Syndrome (ACS).
2 Cholesterol Management in patients with cardiovascular conditions includes the percentage of PCI patients who had a low-density lipoprotein cholesterol (LDL-C) screening performed and the percentage of patients who have a documented LDL-C level less than 130 mg/dL and less than 100 mg/dL.
3 All PCIs is the sum of all Inpatient PCI AND Outpatient PCI procedures. For COAP and The Leapfrog Group, this information is self-reported by hospitals. For programs measuring PCIs on inpatients only, administrative data sources are utilized.
4 Risk-adjustment models vary according to registry. COAP risk-adjusts mortality with its own statistical model. AHRQ's IQIs use crude mortality rates (non-risk-adjusted mortality). NQF's Consensus Standards for Hospital Care utilize either crude mortality or ACC-NCDR risk adjusted logistic regression model.
The Leapfrog Group assigns a quartile mortality performance based upon self-reported data from either the "Leapfrog Survey" or ACC-NCDR performance of ‘worse than national average’ or ‘better than national average.’ The risk-adjustment will follow the ACC or New York State statistical model, if appropriate. Based on either source, this binary disposition accounts for 34% of the scoring per Leapfrog's methodology. Because of this adjustment, a hospital's placement in a Leapfrog quartile does not convey whether its risk-adjusted mortality rate is statistically significantly different from (a) the statewide average, or (b) another hospital in its quartile, or (c) another hospital in a different quartile.
5 The NQF Consensus Standards for Hospital Care and AHRQ IQI measures for PCIs do not include outpatient procedures since ICD-9-CM procedure codes were named as the HIPAA standard code set for inpatient hospital procedures only and not for other settings such as hospital outpatient services or other types of ambulatory services. Hospitals may capture the ICD-9-CM procedure codes for internally tracking or monitoring hospital outpatient services; but when conducting standard transactions, hospitals must use Healthcare Common Procedure Coding System (HCPCS) codes to report. The HCPCS Level 1 Code set include Current Procedure Terminology (CPT) codes that are maintained by the AMA.
6 AHRQ uses both 200/year and 400/year thresholds without offically endorsing any PCI volume standard. Current ACC/AHA standards are >200 PCIs per year per facility and >75 PCIs per year per cardiologist.
[REFERENCE: Smith SC, Jr, Dove JT, Jacobs AK, Kennedy JW, Kereiakes D, Kern MJ, Kuntz RE, Popma JJ, Schaff HV, Williams DO. "ACC/AHA guidelines for percutaneous coronary intervention: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1993 Guidelines for Percutaneous Transluminal Coronary Angioplasty)." J Am Coll Cardiol 2001;37:2215–38.]
