BACKGROUND: Coronary artery disease (CAD) outcomes consistently improve when they are routinely measured and provided back to physicians and hospitals. However, few centers around the world systematically track outcomes, and no global standards exist. Furthermore, patient-centered outcomes and longitudinal outcomes are under-represented in current assessments. METHODS AND RESULTS: The nonprofit International Consortium for Health Outcomes Measurement (ICHOM) convened an international Working Group to define a consensus standard set of outcome measures and risk factors for tracking, comparing, and improving the outcomes of CAD care. Members were drawn from 4 continents and 6 countries. Using a modified Delphi method, the ICHOM Working Group defined who should be tracked, what should be measured, and when such measurements should be performed. The ICHOM CAD consensus measures were designed to be relevant for all patients diagnosed with CAD, including those with acute myocardial infarction, angina, and asymptomatic CAD. Thirteen specific outcomes were chosen, including acute complications occurring within 30 days of acute myocardial infarction, coronary artery bypass grafting surgery, or percutaneous coronary intervention; and longitudinal outcomes for up to 5 years for patient-reported health status (Seattle Angina Questionnaire [SAQ-7], elements of Rose Dyspnea Score, and Patient Health Questionnaire [PHQ-2]), cardiovascular hospital admissions, cardiovascular procedures, renal failure, and mortality. Baseline demographic, cardiovascular disease, and comorbidity information is included to improve the interpretability of comparisons. CONCLUSIONS: ICHOM recommends that this set of outcomes and other patient information be measured for all patients with CAD.
AimThe primary goal of this initiative was to identify a parsimonious, consensus, set of outcomes with standard definitions for patients with CAD that could be tracked by health systems and clinical registries around the world. In particular, this standard set would encompass a range of outcomes relating to mortality, morbidity, and patient health status (ie, symptoms, functional status, and health-related quality of life). The use of a standard set of outcome measurements would not preclude any system or registry collecting and reporting additional measures as desired. A secondary goal was to identify a standard set of variables to be systematically collected to enable case-mix adjustment, which would support comparison of CAD outcomes among providers and health systems with different case mixes of patients.
ContributorsMcNamara, R. L. Spatz, E. S. Kelley, T. A. Stowell, C. J. Beltrame, J. Heidenreich, P. Tresserras, R. Jernberg, T. Chua, T. Morgan, L. Panigrahi, B. Rosas Ruiz, A. Rumsfeld, J. S. Sadwin, L. Schoeberl, M. Shahian, D. Weston, C. Yeh, R. Lewin, J.
Disease Category: Heart & circulation
Disease Name: Angina (stable angina pectoris), Coronary artery disease
Age Range: Unknown
Sex: Either
Nature of Intervention: Any
- Clinical experts
- Patient/ support group representatives
- Policy makers
- Researchers
- Service commissioners
- COS for practice
- COS for registry
- COS for clinical trials or clinical research
- Delphi process
- Teleconferences
A modified Delphi technique was used to develop consensus around all major decision areas, including the scope of the
population to be covered, the minimum outcome set, and the risk factors required for case-mix adjustment. Consistent with this method, a combination of teleconferences and surveys was used to forge consensus. Between December 2012 and November 2013, the Working Group participated in 11 conference calls, 10 of which were followed by surveys on key decision points. Prior to each teleconference, the ICHOM project team developed an agenda, listed key proposals, and summarized relevant evidence from the literature. The Working Group reviewed these documents in advance and discussed them during each teleconference.
Following each call, the ICHOM team circulated detailed minutes and an electronic survey on each key decision point.
Decisions were finalized when more than two thirds of the Working Group members concurred. In cases where consensus was not achieved, further discussion ensued during subsequent teleconferences, which was followed by a second survey. The final standard set was approved unanimously by all members of the Working Group.