Measuring percutaneous coronary intervention quality by simple case volume.

Monitoring health care and developing metrics to gauge optimum systems from suboptimum ones is a multidimensional effort that spans the spectrum of health services research and administration. The quality assessment tools for operative procedures range from policies requiring measurement of general compliance within medical society guidelines, in terms of medical indications and procedural techniques, to local hospital peer review and medical executive committee oversight focused on case review. Although these quality measures are certainly labor intensive and require the highest level of objective reasoning and judgment, simpler metrics have been proposed that offer better ease of use and objectivity. Probably the most practical of the simpler methods for operative procedures is the measurement of periodic operative count, usually by physician and hospital, and a comparison of this count to a specified number or threshold felt to signify the highest quality. Inherent in this comparison of volume and quality is the operation-specific assessment of volume and outcomes to support the notion of a positive or negative (ie, not flat) relationship. In virtually all analyses in which a significant relationship has been demonstrated, an inverse relationship between volume and adverse outcomes was seen.1,2 Such relationships have also been seen for percutaneous coronary interventions (PCI), and the American College of Cardiology and American Heart Association (AHA/ACC) Joint Task Force guidelines for PCI have recommended minimum threshold goals for hospitals and operators to ensure the highest quality of PCI care.3