Title:
Quality Improvement in the Outpatient Setting: Observations from the PINNACLE Registry® 2009 Q4-2013 Q1
Authors:
Katie Kehoe BSN, MS
1
; Sherry Shultz RN, BSN, CIO
2
; Fran Fiocchi MPH
1
; Qiong Li PhD
1
; Thomas Shields
1
; Charlie Devlin MD FACC, FACP, FASNC
2
; Nathan T Glusenkamp, MA
1
; J. Brendan Mullen
1
; Angelo Ponirakis, PhD
1
;
1
American College of Cardiology, Washington, DC
2
South Carolina Heart Center, Columbia SC
Background:
The PINNACLE Registry® at the American College of Cardiology is the first outpatient practice-based quality improvement program in the United States. Begun as a pilot program in 2007, the registry systematically collects and reports on adherence to clinical guidelines in the care of patients with coronary artery disease, hypertension, atrial fibrillation and heart failure. Over time, these reports offer a unique opportunity for Quality Improvement (QI) in the outpatient setting. The current study aimed to assess the effect of QI in the outpatient setting using PINNACLE Registry data.
Methods:
The South Carolina Heart Center is a cardiovascular practice in Columbia, South Carolina. There are 19 providers, 5 office locations and NextGen EMR. The practice’s Quality Committee and Board meet monthly to review PINNACLE reports and identify areas for QI. This Clinical Quality Improvement Initiative began 10 years ago and consists of physicians, nurses, administrators, medical assistants, a medical record analyst and information systems staff. During this review, providers’ data was not blinded to others. QI Interventions implemented included physician and staff education, improving documentation during the office visit, addition of necessary fields to capture missing data and routine planned internal audits. Between October 1, 2009 and March 31, 2013 a total of 161,873 patient encounters were submitted to the registry. A two-tailed z test was performed to assess the significance in percentage changes between 2009 to 2013.
Results:
The following table showed significant percentage changes in six performance measures indicating interventions implemented by the practice demonstrate significant quality improvement over time from 2009-2013.
Conclusions:
Utilizing their PINNACLE Registry reports, the South Carolina Heart Center identified several areas for QI. Implementing multiple interventions, this practice was able to significantly improve their PINNACLE Reports and the quality of care provided.
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