Compliance for 24 performance measures for coronary artery disease, heart failure and atrial fibrillation ranges from dismal to nearly perfect, according to a new study in JACC using data from the PINNACLE Registry™, ACC’s outpatient registry.

The study, by Paul Chan, M.D., F.A.C.C., and others, found that compliance on ACC/AHA/PCPI performance measures in the three areas ranged as low as 13.3% (for CAD patients screened for diabetes mellitus) to as high as 96.7% (for heart failure patients with blood pressure assessment). The study looked at data from 27 practices and 14,464 patients, for a total of 18,021 clinical visits, enrolled in the PINNACLE Registry between July 2008 and June 2009.

Clearly, these results are mixed. While the nearly 100% adherence to some of the performance measures is fantastic, the lower adherence levels show areas where improvement is necessary. The authors take a “half-glass full” approach to the results:

... [W]hile rates were suboptimal for a number of performance measures, these results identify opportunities for future improvement and provide a valuable benchmark with which progress can be measured.

In addition, the authors note that there were “no substantial racial or sex differences in compliance rates for key performance measures for” CAD, HF and AF.

The PINNACLE Registry, the first outpatient registry to successfully measure performance in the cardiovascular setting, was created for studies like this one. Because we’ve never attempted to measure the quality of care provided in the outpatient setting, we have no idea how good, bad or variable it is. While we might not be completely encouraged by the findings of the study, at least now we know the areas we need to work on.

Challenges Ahead
In an accompanying editorial in JACC, Sunil Rao, M.D., F.A.C.C., admonishes: “The PINNACLE program serves as a reminder that clinical care does not occur in snapshots; it is longitudinal, interrelated, and spans across specialties and diagnoses.”

Challenges exist not only in ensuring the high-quality longitudinal application of evidence-based care but also for the seamless development of PINNACLE to enhance ease of use to assess and improve quality of care. This ambitious effort of the ACC involves the harnessing of the power of IT and informatics so that all electronic medical record vendors are “cross-platform compatible” to have work flow data entry following clinical processes and ensuring data is “auto-populated” so there is no human duplicate data entry across different systems.

The future vision of PINNACLE includes embedding decision support tools using ACC’s appropriate use criteria so that we will be able to not only ensure quality of care but enhance appropriateness in minimizing needless and non-productive testing. This will be necessary to truly “bend the cost curve of health care.”

For more information about PINNACLE or to enroll your practice, visit: https://www.pinnacleregistry.org.