RESUMEN
Interventional cardiology has finally completed, after 26 years of advocacy, a professional hat trick: independent board certification, membership as a unique specialty in the American Medical Association House of Delegates (AMA HOD), and recognition by the Centers for Medicaid and Medicare Services (CMS) as a separate medical specialty. This article points out how these distinctions for interventional cardiology and its professional society, the Society for Cardiovascular Angiography and Interventions (SCAI), have led to clear and definite benefits for interventional cardiologists and their patients. We focus on the least understood of these three-recognition by CMS and its implications for reimbursement and quality assessment for interventional cardiologists. © 2016 Wiley Periodicals, Inc.
Asunto(s)
Cateterismo Cardíaco/clasificación , Cardiología/clasificación , Centers for Medicare and Medicaid Services, U.S. , Cateterismo Cardíaco/economía , Cateterismo Cardíaco/normas , Cardiología/economía , Cardiología/normas , Centers for Medicare and Medicaid Services, U.S./economía , Centers for Medicare and Medicaid Services, U.S./normas , Certificación , Competencia Clínica , Humanos , Reembolso de Seguro de Salud , Indicadores de Calidad de la Atención de Salud , Sociedades Médicas , Especialización/economía , Especialización/normas , Consejos de Especialidades , Estados UnidosAsunto(s)
Cateterismo Cardíaco/clasificación , Cardiología/clasificación , Difusión de Innovaciones , Trasplante de Corazón/clasificación , Implantación de Prótesis de Válvulas Cardíacas/clasificación , Terminología como Asunto , Cateterismo Cardíaco/historia , Cateterismo Cardíaco/tendencias , Cardiología/historia , Cardiología/tendencias , Epónimos , Trasplante de Corazón/historia , Trasplante de Corazón/tendencias , Implantación de Prótesis de Válvulas Cardíacas/historia , Implantación de Prótesis de Válvulas Cardíacas/tendencias , Historia del Siglo XX , HumanosAsunto(s)
Cateterismo Cardíaco , Reserva del Flujo Fraccional Miocárdico , Intervención Coronaria Percutánea , Terminología como Asunto , Ultrasonografía Intervencional , Cateterismo Cardíaco/clasificación , Competencia Clínica , Curriculum , Educación de Postgrado en Medicina , Humanos , Curva de Aprendizaje , Intervención Coronaria Percutánea/clasificación , Intervención Coronaria Percutánea/educación , Valor Predictivo de las Pruebas , Ultrasonografía Intervencional/clasificaciónRESUMEN
OBJECTIVE: We sought to determine the relationship between relative value units (RVUs) and intended measures of work in catheterization for congenital heart disease. METHODS: RVU was determined by matching RVU values to Current Procedural Terminology codes generated for cases performed at a single institution. Differences in median case duration, radiation exposure, adverse events, and RVU values by risk category and cases were assessed. Interventional case types were ranked from lowest to highest median RVU value, and correlations with case duration, radiation dose, and a cases-predicted probability of an adverse event were quantified with the Spearman rank correlation coefficient. RESULTS: Between January 2008 and December 2010, 3557 of 4011 cases were identified with an RVU and risk category designation, of which 2982 were assigned a case type. Median RVU values, radiation dose, and case duration increased with procedure risk category. Although all diagnostic cases had similar RVU values (median 10), adverse event rates ranged from 6% to 21% by age group (P < .001). Median RVU values ranged from 9 to 54 with the lowest in diagnostic and biopsy cases and increasing with isolated and then multiple interventions. Among interventional cases, no correlation existed between ranked RVU value and case duration, radiation dose, or adverse event probability (P = .13, P = .62, and P = .43, respectively). CONCLUSIONS: Time, skill, and stress inherent to performing catheterization procedures for congenital heart disease are not captured by measurement of RVU alone.
Asunto(s)
Cateterismo Cardíaco/clasificación , Cateterismo Cardíaco/estadística & datos numéricos , Cardiología/estadística & datos numéricos , Cardiopatías Congénitas/clasificación , Pediatría/estadística & datos numéricos , Escalas de Valor Relativo , Especialización/estadística & datos numéricos , Adolescente , Boston , Cateterismo Cardíaco/efectos adversos , Niño , Preescolar , Current Procedural Terminology , Tabla de Aranceles/clasificación , Tabla de Aranceles/estadística & datos numéricos , Femenino , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/terapia , Sistemas de Información en Hospital , Humanos , Lactante , Recién Nacido , Masculino , Medicare/estadística & datos numéricos , Probabilidad , Dosis de Radiación , Radiología Intervencionista/clasificación , Radiología Intervencionista/estadística & datos numéricos , Medición de Riesgo , Resultado del Tratamiento , Estados UnidosRESUMEN
Interventional cardiology for paediatric and congenital cardiac disease is a relatively young and rapidly evolving field. As the profession begins to establish multi-institutional databases, a universal system of nomenclature is necessary for the field of interventional cardiology for paediatric and congenital cardiac disease. The purpose of this paper is to present the results of the efforts of The International Society for Nomenclature of Paediatric and Congenital Heart Disease to establish a system of nomenclature for cardiovascular catheterisation for congenital and paediatric cardiac disease, focusing both on procedural nomenclature and the nomenclature of complications associated with interventional cardiology. This system of nomenclature for cardiovascular catheterisation for congenital and paediatric cardiac disease is a component of The International Paediatric and Congenital Cardiac Code. This manuscript is the second part of the two-part series. Part 1 covered the procedural nomenclature associated with interventional cardiology as treatment for paediatric and congenital cardiac disease. Part 2 will cover the nomenclature of complications associated with interventional cardiology as treatment for paediatric and congenital cardiac disease.
Asunto(s)
Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/clasificación , Terminología como Asunto , Comités Consultivos , Codificación Clínica , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/terapia , Humanos , Relaciones Interprofesionales , Pediatría , Sistema de Registros , Sociedades MédicasRESUMEN
Interventional cardiology for paediatric and congenital cardiac disease is a relatively young and rapidly evolving field. As the profession begins to establish multi-institutional databases, a universal system of nomenclature is necessary for the field of interventional cardiology for paediatric and congenital cardiac disease. The purpose of this paper is to present the results of the efforts of The International Society for Nomenclature of Paediatric and Congenital Heart Disease to establish a system of nomenclature for cardiovascular catheterisation for congenital and paediatric cardiac disease, focusing both on procedural nomenclature and on the nomenclature of complications associated with interventional cardiology. This system of nomenclature for cardiovascular catheterisation for congenital and paediatric cardiac disease is a component of The International Paediatric and Congenital Cardiac Code. This manuscript is the first part of a two-part series. Part 1 will cover the procedural nomenclature associated with interventional cardiology as treatment for paediatric and congenital cardiac disease. This procedural nomenclature of The International Paediatric and Congenital Cardiac Code will be used in the IMPACT Registry™ (IMproving Pediatric and Adult Congenital Treatment) of the National Cardiovascular Data Registry® of The American College of Cardiology. Part 2 will cover the nomenclature of complications associated with interventional cardiology as treatment for paediatric and congenital cardiac disease.
Asunto(s)
Cateterismo Cardíaco/clasificación , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/terapia , Terminología como Asunto , Comités Consultivos , Codificación Clínica , Humanos , Relaciones Interprofesionales , Pediatría , Sistema de Registros , Sociedades MédicasRESUMEN
Transradial approach is known to reduce access-site complications of coronary procedures. However, the diffusion of transradial approach in the interventional cardiology community is limited by its higher failure rate compared to transfemoral. Transradial approach failures are mainly caused by a series of anatomic variants which may be encountered in the upper limb arteries. Such anatomic variants have been variously classified based on postmortem studies or systematic angiographic studies. We propose a simplified "operative" classification of anatomic vascular variants and physiopathologic conditions of the arterial axis, from radial to aortic root, possibly affecting transradial cardiovascular procedures.
Asunto(s)
Cateterismo Cardíaco/clasificación , Enfermedad Coronaria/clasificación , Enfermedad Coronaria/patología , Arteria Radial/anatomía & histología , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/tendencias , Enfermedad Coronaria/terapia , Humanos , Insuficiencia del TratamientoRESUMEN
OBJECTIVE: We sought to develop a method to adjust for case mix diversity and allow comparison of adverse outcome rates among practitioners in pediatric and congenital cardiac catheterization. PATIENTS AND METHODS: A single institutional database that captured demographic and procedural data was used to identify patient and procedural characteristics associated with adverse events (AE) and any high severity event classified as preventable or possibly preventable (P/PP). Diagnostic and procedural risk groups were created and indicators of hemodynamic vulnerability were defined. Expected event rates by the practitioners adjusting for case mix were calculated. Standardized adverse event ratios (SAER), defined as the observed rate divided by the expected rate for each practitioner were calculated with 95% confidence intervals. RESULTS: The database included 1727 hemodynamic (30%) and interventional (70%) cases performed by seven practitioners in 18 months. During 147 cases, at least one P/PP AE occurred; among the seven practitioners observed, event rates ranged from 3.2 to 14.2%. In multivariable analysis, risk factors for all P/PP events included highest procedure risk group (odds ratio [OR] 2.1 for group 2, and 2.8 for group 3, relative to group 1, P = .001 and P < .001, respectively) and weight less than 4 kg (OR 2.8, P < .001). High severity P/PP events occurred in 67 cases with rates ranging from 2.0 to 6.6% by the practitioners. For these events, risk factors included: highest procedure risk group (OR 4.5 for group 2, and 4.9 for group 3, both P < .001) and an indicator of hemodynamic vulnerability (OR 1.8, P = .026). For the seven practitioners, the SAER ranged from 0.41 to 1.32 for any P/PP AE and from 0.69 to 1.44 for P/PP high severity events. In this cohort, we did not identify any statistically significant performance differences. CONCLUSION: Despite wide variations in case mix complexity in pediatric and congenital cardiac catheterization, this study demonstrates a method for risk adjustment which allows equitable comparisons among practitioners at a single institution.
Asunto(s)
Cateterismo Cardíaco/efectos adversos , Cardiopatías Congénitas/diagnóstico , Evaluación de Resultado en la Atención de Salud , Pediatría/normas , Ajuste de Riesgo/métodos , Cateterismo Cardíaco/clasificación , Niño , Competencia Clínica , Intervalos de Confianza , Bases de Datos Factuales , Humanos , Análisis Multivariante , Oportunidad Relativa , Radiografía Intervencional , Factores de RiesgoRESUMEN
About three years ago, the German Government initiated a complete change in the reimbursement system for costs of the in-hospital treatment of patients. A commission of representatives from every component of the German health system decided to adapt the Australian refined Diagnosis Related Groups (AR-DRG system). The AR-DRG system was selected as it would fit best to the German system and because of its high flexibility and preciseness reflecting severity of diseases and treatments. In October 2002, the first German Diagnosis Related Groups (G-DRGs) were calculated from the data of about 116 hospitals. These data now allow first analyses in how far a correct and precise grouping of patients in specific hospital settings is indeed performed and corresponds to the actual costs. Thus, we thoroughly calculated all costs for material and personnel during the in-hospital stay for each patient discharged during the first 4 months of 2002 from our cardiological department. After performing the grouping procedure for each patient, we analyzed in how far inhomogeneous patient distribution in the DRGs occurred and which impact this had on costs and potential reimbursements. Several different problems were identified which should be outlined in this work regarding three G-DRGs: costs of patients who received an implantable cardioverter defibrillator (F01Z) were markedly influenced by multimorbidity and additional expensive interventions which were not reflected by this G-DRG. Use of numerous catheters and expensive drugs represented a major factor for costs in patients with coronary angioplasty in acute myocardial infarction (F10Z) but seemed to be not sufficiently included in the cost weight. A specific area of patient management in our department is high frequency ablation of tachyarrhythmias which is included in other percutaneous interventions (F19Z). Complex procedures such as ablation of ventricular tachycardia or new innovative procedures as ablation of atrial fibrillation were associated with high costs leading to inadequate reimbursement. Furthermore, problems in the associated codes for diseases and procedures became apparent. Opportunities for future optimization such as specific new DRGs, splitting of DRGs, or the impact of changes in reimbursement for high-outliers were discussed.