David Eccleston1, Mark Horrigan2, Tony Rafter3, Geoffrey Holt4, Stephen G Worthley5, Peter Sage6, Alan Whelan7, Christopher Reid8, Peter L Thompson9. 1. GenesisCare, Sydney, NSW, Australia, Department of Medicine, University of Melbourne, Melbourne, Vic, Australia, Cardiology Department, Royal Melbourne Hospital, Melbourne, Vic, Australia. Electronic address: david.eccleston@mh.org.au. 2. Austin Health, HeartCare Victoria, Melbourne, Vic, Australia. Electronic address: Mark.Horrigan@hcvic.com.au. 3. HeartCare Partners Brisbane, Qld, Australia. Electronic address: TRafter@heartcarepartners.com.au. 4. HeartCare Partners Brisbane, Qld, Australia. Electronic address: gwholt@heartcarepartners.com.au. 5. Royal Adelaide Hospital Adelaide Cardiology, Adelaide, SA, Australia. Electronic address: Stephen.Worthley@genesiscare.com.au. 6. Adelaide Cardiology, Adelaide, SA, Australia. Electronic address: psage@adelaidecardiology.com.au. 7. HeartCare WA, Perth, WA, Australia. Electronic address: alan.whelan@heartcarewa.com.au. 8. NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement, Curtin University Director, CCRE Therapeutics, Monash University, Melbourne, Vic, Australia. Electronic address: christopher.reid@curtin.edu.au. 9. Cardiologist and Director of the Heart Research Institute Sir Charles Gairdner Hospital Clinical Professor of Medicine University of Western Australia Deputy Director, Harry Perkins Institute of Medical Research, Perth, WA, Australia. Electronic address: peterlthompson@bigpond.com.
Abstract
BACKGROUND: Secondary prevention strategies after percutaneous coronary intervention (PCI) include statins and dual anti-platelet therapy, however there are significant gaps between guidelines and practice. Contemporary PCI practice requires comprehensive data collection to allow dynamic auditing and benchmarking of key performance and safety indices. Genesis HeartCare is Australia's largest collaborative venture of cardiologists, practising at over 40 public and private hospitals. We hypothesised that measurement and local reporting of data would improve patient outcomes through improving compliance with guideline therapies. METHODS: Real-time benchmarking via a national clinical quality and outcomes register, the Genesis Cardiovascular Outcomes Registry (GCOR-PCI). GCOR-PCI prospectively collected clinical, procedural, medication and outcomes data for 6720 consecutive patients undergoing PCI from 10 private hospitals across Australia. Key performance outcomes benchmarked against the aggregated study cohort and international standards were reported to individual sites. The main outcome measure was compliance with guideline medications (statins, anti-platelet agents). RESULTS: Early data identified specific practice patterns associated with lower rates of statin therapy post-PCI, which led to changes in practice. Between the first and latest year of data collection there was significant improvement in the rates of statin therapy at discharge (92.1 vs. 94.4% p<0.03) and 12 months post-PCI (87.0 vs. 92.2% p<0.001) and of antiplatelet therapy at 12 months (90.7 vs. 94.3% p<0.001). CONCLUSIONS: This large-scale collaboration provides a platform for the development of quality improvement initiatives. Establishment of this clinical quality registry improved patient care by identifying and monitoring gaps in delivery of appropriate therapies, driving key practice change.
BACKGROUND: Secondary prevention strategies after percutaneous coronary intervention (PCI) include statins and dual anti-platelet therapy, however there are significant gaps between guidelines and practice. Contemporary PCI practice requires comprehensive data collection to allow dynamic auditing and benchmarking of key performance and safety indices. Genesis HeartCare is Australia's largest collaborative venture of cardiologists, practising at over 40 public and private hospitals. We hypothesised that measurement and local reporting of data would improve patient outcomes through improving compliance with guideline therapies. METHODS: Real-time benchmarking via a national clinical quality and outcomes register, the Genesis Cardiovascular Outcomes Registry (GCOR-PCI). GCOR-PCI prospectively collected clinical, procedural, medication and outcomes data for 6720 consecutive patients undergoing PCI from 10 private hospitals across Australia. Key performance outcomes benchmarked against the aggregated study cohort and international standards were reported to individual sites. The main outcome measure was compliance with guideline medications (statins, anti-platelet agents). RESULTS: Early data identified specific practice patterns associated with lower rates of statin therapy post-PCI, which led to changes in practice. Between the first and latest year of data collection there was significant improvement in the rates of statin therapy at discharge (92.1 vs. 94.4% p<0.03) and 12 months post-PCI (87.0 vs. 92.2% p<0.001) and of antiplatelet therapy at 12 months (90.7 vs. 94.3% p<0.001). CONCLUSIONS: This large-scale collaboration provides a platform for the development of quality improvement initiatives. Establishment of this clinical quality registry improved patient care by identifying and monitoring gaps in delivery of appropriate therapies, driving key practice change.
Authors: David Eccleston; Gregory Scalia; Leighton Kearney; David Cross; Daniel Cehic; Patrick Disney; Xiao-Fang Xu; Peter Cain; Piyush M Srivastava Journal: Open Heart Date: 2022-05