Health Affairs, 26, no. 1 (2007): 61 doi: 10.1377/hlthaff.26.1.61 © 2007 by Project HOPE	New Online   Pay Cuts For Medicare Docs   Access To Care Woes   Public Coverage More Efficient   Empowering Consumers

This Article Extract Reprint (PDF) Submit a response to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My Personal Archive Download to Citation Manager Reprints & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content Related Collections Cardiovascular Disease Quality Of Care

Quality

PROLOGUE

Improving The Quality Of Cardiovascular Disease Care

As Robert Califf and colleagues from Duke University explain in the first of the following three papers, clinical research "findings are often sequestered in internal files of pharmaceutical and device companies or the FDA," forcing duplication of costly research efforts. Research infrastructures may be built from scratch for a single clinical trial and then torn down again, forcing more duplication and delay. The lack of data standards and interoperability is an additional source of inefficiency. Further downstream in the process of improving the quality and effectiveness of care, uncoordinated performance incentives in a multipayer system risk "creating further disarray in delivery systems and worsening inequities."

Somewhat paradoxically, it might be easier to strike a balance between competition and collaboration within a specialized discipline such as cardiology than across the health system as a whole, where the centrifugal forces are simply too overwhelming. Califf and colleagues have a plan, and if they can get traction with it, their field could set an example for others. Because of the rapid pace of innovation in cardiovascular disease care, the field may have other lessons as well for managing quality at the sharp edge of change.

For example, in a second paper in the section, Yale University’s Harlan Krumholz and colleagues explore the difficult challenge of developing outcome-based performance measures for cardiovascular care. Their discussion notes that principles developed jointly by the American Heart Association and the American College of Cardiology provide a foundation for severity-adjusted measures of hospital performance based on claims data, a potentially path-breaking development.

Finally, Rita Redberg of the University of California, San Francisco, explores the difficulties that a pluralistic system has in saying "No" to new technologies with seductive promise but unproven value. Using the example of computed tomography angiography, she shows how coverage decisions by Medicare and private insurers may depend on ad hoc processes for evaluating available evidence, and she highlights the need for more-structured approaches.

                      What's this?