Background
In 1996 the association of German Cardiologists in private practice (BNK) installed a computer based quality registry that collects all diagnostic (DHC) and therapeutic heart catheterization (PCI) procedures. Today, 20 % of these procedures are performed by cardiologists in private practice. The participation in the registry is voluntary, and self financed. QuIK is the German acronym for “Quality Assurance in Invasive Cardiology”.
Method:
Procedural quality related data are collected in the cath lab and the corresponding data set exported regularly to a central data administration centre. Data are analyzed every quarter and every year. Participating cardiologists are provided with a single centre and a combined group result table and picture report including a centre/group comparison.
Results:
The QuIK registry, though not obligatory, accounts for almost 80 % of procedures, done by cardiologists in private practice. Since 1996 over 1 million (800,000 DHC and 230,000 PCI) procedures have been collected (as at 30 September 2009). The development of datasets and statistical analysis is discussed by all participating cardiologists. Data quality and reliability is proved in a yearly monitoring process in the participating cath lab, also facultative, but done in 70 % of private practices. In 1996, eight centres sent their data, in 2008, there were 123 participating institutions. In 2008, in 65 % of 76,513 cases, a coronary heart disease (CHD) was confirmed, but 40 % had already CHD and were symptomatic, again. Even 12 % showed signs of an acute coronary syndrome (ACS). In 40 % revascularization was indicated (11 % surgery and 29 % PCI). Of the PCI decisions, 80 % were done ad hoc. The 21,438 PCI cases had an acute complication rate of 1.5 %, most of were acute thromboses, 0.1 % of patients died in cath lab. 4 of 5 cases were treated with a stent, 1 of 5 with a drug eluting stent. Angiographic success rate was 93 %.
Conclusion:
One characteristic of the idea of quality management with the aim of “pay for performance” (p4p) is the voluntary and self-directed initiative in a competitive environment to confirm and raise the quality of care. It is done with the intention to help patients and their family doctors when choosing a cardiologist.
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