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Abstracts and presentations are embargoed for release at date and time of presentation or time of AHA/ASA news event. Information may not be released before then. Failure to honor embargo policies will result in the abstract being withdrawn and barred from presentation.
PosterSession Title: Poster Session II

Abstract 245: Achieving Appropriate Use Metrics for Angioplasty

William E Lawson, Lisa Wilbert, Kellie Gumersell, Lisa Sokoloff, Carolyn Santora, Anil Mani
Circulation: Cardiovascular Quality and Outcomes. 2014;7:A245
William E Lawson
SUNY STONY BROOK, Stony Brook, NY
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Lisa Wilbert
SUNY STONY BROOK, Stony Brook, NY
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Kellie Gumersell
SUNY STONY BROOK, Stony Brook, NY
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Lisa Sokoloff
SUNY STONY BROOK, Stony Brook, NY
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Carolyn Santora
SUNY STONY BROOK, Stony Brook, NY
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Anil Mani
SUNY STONY BROOK, Stony Brook, NY
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Abstract

Background: With the development of appropriate use metrics for coronary angioplasty, application of these criteria to the NYS PCI data base resulted in 14.3% of PCIs in NYS being deemed “inappropriate”. While “inappropriate” has been changed to “rarely appropriate’’ in professional society guidelines, public interpretation of this designation, medicolegal issues, and reimbursement for procedures in this category remain concerns. Because the bulk of PCI procedures are ad hoc, appropriateness of treatment is largely determined by preprocedural documentation and treatment.

Procedure: The 2010 SBUH “inappropriate” PCI rate from NYS was utilized as a baseline and compared with post intervention Qtr 4, 2012 - Qtr 3, 2013. Trained abstractors audited charts to identify patients that would potentially be classified “inappropriate” and determine which data elements were missing most frequently. A preprocedural screening tool was developed and implemented to establish PCI appropriateness as supported by adequate documentation and preprocedural medical therapy. Pretest outpatient NP screening identified and addressed concerns identified by using the preprocedural tool. A monthly meeting was organized where Physician Specific compliance reports that had been created were reviewed.

Results: Baseline “inappropriate” interventions at SBUH comprised 24.8% of total PCI. Inappropriate classification was due to both inadequate documentation and less than optimal medical therapy. Implementation of the PCI AU tool resulted in a sustained decline in the “inappropriate” procedures to 1.6% (NCDR mean 2.5% for this time period). An additional unanticipated benefit of the process has been that the feedback provided to referring attendings continues to improve required documentation and medical therapy supporting PCI revascularization. The tool will be shared at presentation.

Conclusions: The combination development of a PCI screening tool for potential ad hoc intervention patients and outpatient review of documentation and medical therapy allowed a substantial improvement in PCI appropriateness. Appropriate feedback to referring physicians augmented the effect of these process changes and improved appropriate utilization.

  • appropriate use
  • angioplasty
  • process improvement
  • Author Disclosures: W.E. Lawson: None. L. Wilbert: None. K. Gumersell: None. L. Sokoloff: None. C. Santora: None. A. Mani: None.

  • © 2014 by American Heart Association, Inc.
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July 2014, Volume 7, Issue Suppl 1
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    Abstract 245: Achieving Appropriate Use Metrics for Angioplasty
    William E Lawson, Lisa Wilbert, Kellie Gumersell, Lisa Sokoloff, Carolyn Santora and Anil Mani
    Circulation: Cardiovascular Quality and Outcomes. 2014;7:A245, originally published June 2, 2014

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    Abstract 245: Achieving Appropriate Use Metrics for Angioplasty
    William E Lawson, Lisa Wilbert, Kellie Gumersell, Lisa Sokoloff, Carolyn Santora and Anil Mani
    Circulation: Cardiovascular Quality and Outcomes. 2014;7:A245, originally published June 2, 2014
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