Editorial CommentClinical Guidelines and Performance Measures: Responsible Guidance and Accountability
Section snippets
Clinical Practice Guidelines
Since the early 1980s, the ACCF and the AHA have engaged in a joint effort to develop clinical practice guidelines, consistent with the mission of both organizations to improve the quality of care and outcomes for patients with cardiovascular disease and fostered by evidence of substantial variation in rates of adherence to evidence-based therapies. Each guideline represents a summary and synthesis of the available evidence by a writing committee, which is vetted through an exhaustive process
Performance Measures
With respect to performance measures, we agree that not all guideline recommendations are appropriate for performance measurement. Indeed, as Ghali et al.1 point out, although the heart failure guideline contains dozens of Class I recommendations, a select few of these processes of care have been incorporated into performance measures. The strongest evidence base, while necessary for the development of performance measures, is by no means sufficient. As delineated in detailed methodology
Industry, Guidelines, and Performance Measures
The ACCF and AHA share the concern voiced by Ghali et al.1 about the potential conflicts of interest from industry in the development of guideline and performance measures. Recognizing this, the ACCF and AHA have an explicit, and relatively stringent, policy on relationships with industry and other entities for writing group membership, including restrictions on the number of writing group members who can have relevant conflicts and restricting the writing and voting on specific sections of the
Conclusions
The ACCF and AHA TFPG and TFPM are aware of the gap between “what we truly know, what we think we know, and what we would like to know.” This gap is the precise reason for the characterization of the level of evidence in guideline recommendations, for the approach to writing recommendations, for the reluctance to generate recommendations concerning subgroups without adequate supporting evidence, and for the methodical process to determine which Class I guideline recommendations qualify for
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Cited by (1)
Association of National Hospital Quality Measure adherence with long-term mortality and readmissions
2012, BMJ Quality and Safety
This paper is being simultaneously copublished in the Journal of the American College of Cardiology, Volume 56, Issue 25.
Dr. Masoudi is the chair of the ACCF/AHA Task Force on Performance Measures; is an Associate Professor of Medicine at the Denver Health Medical Center Division of Cardiology; has served as a consultant for Axio Research; and has received financial benefit from the American College of Cardiology, American Heart Association, the Oklahoma Foundation for Medical Quality, and the Massachusetts Medical Society. Dr. Peterson is the incoming chair for the ACCF/AHA Task Force on Performance Measure (term begins in January 2011); is a professor of medicine and director of cardiovascular outcomes for the Duke Clinical Research Institute; is a consultant for AstraZeneca and Tethysbio; and has done personal research for Bristol-Myers Squibb/Sanofi, Eli Lilly, Johnson & Johnson, and Merck and Schering. Dr. Anderson is the incoming chair of the ACCF/AHA Task Force on Practice Guidelines (term begins in January 2012); is an Associate Chief of Cardiology for the Intermountain Medical Center; has done research for the AstraZeneca, FUTURE-OASIS-CURRENT study, TIMI-48,-51, and -52 studies, and Toshiba; has received financial benefit from the COAG study, CORAL study, CoumaGenil study, and the GIFT study; and was an expert witness in 2010 for the defense for the management of cardiopulmonary arrest post-op and stroke after ablation for atrial fibrillation. Dr. Bonow is the past chair of the ACCF/AHA Task Force on Performance Measures; is the Chief of the Division of Cardiology, for Northwestern University Feinberg School of Medicine; and is a consultant for Edwards Lifesciences. Dr. Jacobs is the chair of the ACCF/AHA Task Force on Practice Guidelines; is a professor of medicine and director of the cardiac catheterization lab for Boston University Medical Center; and has done personal research for Abbott Vascular, Abiomed, Accumetrics, Cardiovascular Research Foundation, Harvard Clinical Research Institute, and the TIMI study group. This paper is being simultaneously copublished in the Journal of the American College of Cardiology.