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. Author manuscript; available in PMC: 2021 Dec 28.
Published in final edited form as: JACC Cardiovasc Interv. 2020 Dec 28;13(24):2853–2864. doi: 10.1016/j.jcin.2020.09.002

Table 3:

Organizations measuring quality of pediatric/congenital cardiac catheterization programs and metrics measured by each

ORGANIZATION QUALITY METRICS:
Agency for Healthcare Research and Quality (AHRQ) www.qualityindicators.ahrq.gov None
American Academy of Pediatrics/American College of Cardiology/Society for Cardiac Angiography and Intervention Consensus Recommendations(14) STRUCTURE

  1. Directed by board certified pediatric cardiologist with additional fellowship (or other experience) in interventional cardiac catheterization

  2. Each case staffed by a board certified or board eligible pediatric cardiologist AND one pediatric nurse with expertise in airway/sedation

  3. Biplane laboratory

  4. Physiologic recording system, crash cart, and supply of catheters

  5. Appropriate ICU (not specifically pediatric cardiac intensive care unit)

  6. In house surgical back-up
PROCESS

  1. Prospective data collection about outcomes

  2. Systematic review of outcomes and case complications

OUTCOME

  1. Acknowledge mortality and adverse event rates but no standards

American College of Cardiology Adult Congenital and Pediatric Cardiology Section (ACC ACPC) Practice Guidelines (16, 17) None
Center for Medicare and Medicaid Services (CMS) cms.gov None
Children’s Hospital Association childrenshospitals.org None
Congenital Cardiovascular Interventional Study Consortium (CCISC) Risk Registry STRUCTURE
 None
PROCESS
 None
OUTCOME

  1. Adverse event rates stratified by pre-procedural risk

  2. Benchmark radiation exposure

Congenital Cardiac Catheterization Project on Outcomes (C3PO) STRUCTURE
 None
PROCESS
 None
OUTCOME

  1. Case-mix adjusted adverse event rates

  2. Benchmark radiation exposure

IMproving Pediatric And Congenital Treatment (IMPACT®) Registry STRUCTURE:
 None
PROCESS

  1. Percentage of cases where all three radiation exposure measurements (fluoroscopy time, skin dose, and dose area product) were reported

OUTCOME
  • 1

    Observed (Raw) adverse events (stratified by age group)*

  • 2

    Technical success for specific procedures#

  • Device in place at end of procedure (ASD closure, PDA closure)

  • Non-trivial residual shunt (ASD closure, PDA closure)

  • Residual gradient (coarctation stent, coarctation angioplasty, balloon pulmonary valvuloplasty)

  • Peak to peak gradient <=40mmHg and regurgitation less than 3+ (aortic valvuloplasty)

  • Ratio of diameter of stented vessel and pre-intervention distal vessel (pulmonary artery stent angioplasty- stratified by single and bi-ventricular patients)

  • 3

    Procedure specific adverse events

  • All (transcatheter pulmonary valve replacement)

  • Device embolization for specific procedures (ASD closure, PDA closure)

* Risk adjusted adverse event rate is listed as a “test metric”
Healthcare Effectivness Data and Infromation Set (HEDIS)
ncqa.org 		None
Health Resources and Services Administration Child
Health Bureau
hrsa.gov 		None
Institute for Healthcare Improvement (IHI)
www.ihi.org 		None
Institute of Medicine/National Academy of Medicine
nam.edu 		None
The Joint Commission
www.jointcommission.org/performance_measurement.aspx 		None
Leapfrog Group
leapfroggroup.org 		None
National Committee for Quality Assurance (NCQA)
www.ncqa.org 		None
National Quality Forum (NQF)
www.qualityforum.org 		None
National Quality Measures Clearinghouse (NQMC)
www.qualitymeasures.ahrq.gov 		None
Patient Centered Outcomes Research Institute (PCORI)
pcori.org 		None
RAND
www.rand.org/health 		None
US News and World Report STRUCTURE

  1. Active fellowship program (overall program)

  2. Reporting data to IMPACT® Registry

  3. Procedure-specific annual case volume (low, medium, or high)

  • Diagnostic cardiac catheterization

  • Endomyocardial biopsy

  • Balloon angioplasty

  • Balloon valvuloplasty

  • Pulmonary stent implantation

  • Coarctation stent implantation

  • Transcatheter occlusion of cardiac shunt

  • Transcatheter placement of stented pulmonary valve

  • Stent redilation

  • Transcatheter occlusion of atrial septal defects

  • Transcatheter occlusion of ventricular septal defects

  • Transcatheter occlusion of patent ductus arteriosus

  • Aortic/pulmonary catheter-based valvuloplasty
PROCESS

  1. Engaging in procedural safety procedures (time out, pre-procedure briefings, and implementation of hand-off procedure)

OUTCOME

  1. None

All measured metrics address concerns about safety except for those identified with a #, which address effectiveness.