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• W2124239768 abstract "HomeCirculationVol. 124, No. 2ACCF/AHA/AMA–PCPI 2011 Performance Measures for Adults With Coronary Artery Disease and Hypertension Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBACCF/AHA/AMA–PCPI 2011 Performance Measures for Adults With Coronary Artery Disease and HypertensionA Report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures and the American Medical Association–Physician Consortium for Performance Improvement Writing Committee Members Joseph DrozdaJr, MD, FACC, Joseph V. Messer, MD, MACC, FAHA, FACP, John Spertus, MD, MPH, FACC, FAHA, Bruce Abramowitz, MD, FACC, Karen Alexander, MD, FACC, Craig T. Beam, CRE, Robert O. Bonow, MD, MACC, FAHA, FACP, Jill S. Burkiewicz, PharmD, BCPS, Michael Crouch, MD, MSPH, David C. GoffJr, MD, PhD, FAHA, FACP, Richard Hellman, MD, FACP, FACE, Thomas JamesIII, MD, FACP, FAAP, Marjorie L. King, MD, FACC, MAACVPR, Edison A. MachadoJr, MD, MBA, Eduardo Ortiz, MD, MPH, Michael O'Toole, MD, FACC, Stephen D. Persell, MD, MPH, Jesse M. Pines, MD, MBA, MSCE, FAAEM, Frank J. Rybicki, MD, PhD, Lawrence B. Sadwin, Joanna D. Sikkema, MSN, ANP-BC, FAHA, Peter K. Smith, MD, Patrick J. Torcson, MD, FACP, MMM and John B. Wong, MD, FACP Writing Committee Members Search for more papers by this author , Joseph DrozdaJrJoseph DrozdaJr *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , Joseph V. MesserJoseph V. Messer *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , John SpertusJohn Spertus *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , Bruce AbramowitzBruce Abramowitz Search for more papers by this author , Karen AlexanderKaren Alexander *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , Craig T. BeamCraig T. Beam *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , Robert O. BonowRobert O. Bonow *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , Jill S. BurkiewiczJill S. Burkiewicz *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , Michael CrouchMichael Crouch *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , David C. GoffJrDavid C. GoffJr *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , Richard HellmanRichard Hellman *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , Thomas JamesIIIThomas JamesIII Search for more papers by this author , Marjorie L. KingMarjorie L. King *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , Edison A. MachadoJrEdison A. MachadoJr *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , Eduardo OrtizEduardo Ortiz Search for more papers by this author , Michael O'TooleMichael O'Toole Search for more papers by this author , Stephen D. PersellStephen D. Persell Search for more papers by this author , Jesse M. PinesJesse M. Pines *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , Frank J. RybickiFrank J. Rybicki *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , Lawrence B. SadwinLawrence B. Sadwin Search for more papers by this author , Joanna D. SikkemaJoanna D. Sikkema *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , Peter K. SmithPeter K. Smith *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author , Patrick J. TorcsonPatrick J. Torcson *, †, ‡, §, ‖, ¶, #, **, ††, ‡‡, §§, ‖‖, ¶¶, ##, ***, ††† Search for more papers by this author and John B. WongJohn B. Wong Search for more papers by this author Originally published13 Jun 2011https://doi.org/10.1161/CIR.0b013e31821d9ef2Circulation. 2011;124:248–270is corrected byCorrectionOther version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2011: Previous Version 1 Table of ContentsPreamble2491. Introduction250 1.1. Scope of the Problem251 1.2. Disclosure of Relationships With Industry251 1.3. Review and Endorsement2512. Methodology251 2.1. Identifying Clinically Important Outcomes251 2.2. Dimensions of Care252 2.3. Literature Review253 2.4. Definition and Selection of Measures2533. ACCF/AHA/AMA–PCPI 2011 Coronary Artery Disease and Hypertension Performance Measures254 3.1. Target Population and Care Period254 3.2. Alignment With Existing Measure Sets and National Guidelines254 3.3. Measures Related to Medication Use254 3.3.1. Prescription Alone Versus Optimal Dosing254 3.3.2. Medication Adherence256 3.4. Outcome Measures2564. Discussion of Changes to the 2005 Measures Set257 4.1. Retirement of 2005 Coronary Artery Disease and Hypertension Measures257 4.1.1. Retirement of Coronary Artery Disease Measure: Screening for Diabetes257 4.2. New Performance Measures in This Update257 4.2.1. Coronary Artery Disease: Symptom Management258 4.2.2. Coronary Artery Disease: Cardiac Rehabilitation Patient Referral From an Outpatient Setting258 4.3. Revised Measures in This Update259 4.3.1. Combining Hypertension Measures: Blood Pressure Measurement and Plan of Care259 4.3.2. Coronary Artery Disease: Smoking Cessation259 4.3.3. Coronary Artery Disease: Lipid Control259 4.3.4. Hypertension and Coronary Artery Disease: Blood Pressure Control259 4.3.5. Coronary Artery Disease: Antiplatelet Therapy260 4.4. Potential Measures Considered but Not Included in This Update261 4.4.1. Coronary Artery Disease: Overuse of Stress Testing261 4.4.2. Measures Related to Appropriate Use of Percutaneous Coronary Intervention, Physiological Testing Before Percutaneous Coronary Intervention, and Treatment Selection for Revascularization261 4.4.3. Measures Related to Shared Decision Making261 4.5. Testing and Research261References262Appendix A. Author Relationships With Industry—ACCF/AHA/AMA–PCPI 2011 Performance Measures for Adults With Coronary Artery Disease and Hypertension266Appendix B. Reviewer Relationships With Industry and Other Entities—ACCF/AHA/AMA–PCPI 2011 Performance Measures for Adults With Coronary Artery Disease and Hypertension268Peterson Eric D., MD, MPH, FACC, FAHAChair, ACCF/AHA Task Force on Performance MeasuresPreambleOver the past decade, there has been an increasing awareness that the quality of medical care delivered in the United States, defined as the delivery of effective, timely, safe, equitable, efficient, and patient-centered medical care, has the potential for improvement.1Consistent with this focus on healthcare quality, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have taken a leadership role in defining “what works in medicine” with their ACCF/AHA guidelines statements, as well as in developing performance measures that define what should or should not be done in the care of patients with cardiovascular disease (Table 1).Table 1. ACCF/AHA Performance Measure SetsTopicOriginal Publication DatePartnering OrganizationsStatusChronic heart failure32005ACC/AHA—inpatient measuresCurrently undergoing updateACC/AHA/PCPI—outpatient measuresCurrently undergoing updateChronic stable coronary artery disease42005ACC/AHA/PCPIUpdated 20114aHypertension52005ACC/AHA/PCPIUpdated 20115aST-elevation and non–ST-elevation myocardial infarction62006ACC/AHAUpdated 20086aCardiac rehabilitation72007AACVPR/ACC/AHAUpdated 2010 (referral measures only)7aAtrial fibrillation82008ACC/AHA/PCPI…Primary prevention of CVD92009ACCF/AHA…Peripheral artery disease102010ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS…Percutaneous coronary intervention2012*ACCF/AHA/SCAI/PCPI/NCQA…Cardiac imaging2012*ACCF/AHA/ACR/PCPI/NCQA…AACVPR indicates American Association of Cardiovascular and Pulmonary Rehabilitation; ACC, American College of Cardiology; ACCF, American College of Cardiology Foundation; ACR, American College of Radiology; AHA, American Heart Association; NCQA, National Committee for Quality Assurance; PCPI, American Medical Association—Physician Consortium for Performance Improvement; SCAI, Society for Cardiac Angiography and Interventions; SIR, Society for Interventional Radiology; SVM, Society for Vascular Medicine; SVN, Society for Vascular Nursing; and SVS, Society for Vascular Surgery.*Planned publication date.The ACCF/AHA Task Force on Performance Measures was originally formed in February 2000 and was charged with identifying the clinical topics appropriate for the development of performance measures and with assembling writing committees composed of clinical and methodological experts. When appropriate, these writing committees have included representation from other organizations involved in the care of patients with the condition of focus. The writing committees are informed about the methodology of performance measure development2 and are instructed to construct measures for broad use that meet these criteria. The writing committees also are directed to strive to create measures that minimize responder burdens and that are aligned with national standards so as to promote harmony among measures.Performance measures can include structural, process, or outcome measures.11 Although implementation of measures of outcomes and efficiency is currently not as well established as that of process measures, it is expected that such measures will become more pervasive over time.Performance measures also vary in the degree of evidence supporting their use and in the information available about how their implementation may affect provider behaviors. Therefore, it is within the scope of the writing committee's task to comment, when appropriate, on the strengths and limitations of external reporting for a particular cardiovascular disease state or patient population. Thus, the metrics contained within this document are categorized as either “performance measures” or “quality measures.” Performance measures are those metrics that the writing committee designates as appropriate for use for both quality improvement and external reporting. In contrast, quality measures are those appropriate for the purposes of quality improvement but not for external reporting until further validation and testing are performed.All measures have limitations and pose challenges to implementation that could result in unintended consequences. The manner in which these issues are addressed is dependent on several factors, including the data collection method, performance attribution, baseline performance rates, incentives, reporting methods used, and the incentives linked to these reports. The ACCF/AHA encourages those interested in implementing these measures for purposes beyond quality improvement to work with the ACCF/AHA to consider these complex issues in pilot implementation projects, to assess limitations and confounding factors, and to guide refinements of the measures to enhance their utility for these additional purposes.By facilitating measurements of cardiovascular healthcare quality, ACCF/AHA performance measurement sets may serve as vehicles to accelerate appropriate translation of scientific evidence into clinical practice. These documents are intended to provide practitioners and institutions that deliver care with tools to measure the quality of their care and identify opportunities for improvement. It is our hope that application of these performance measures will provide a mechanism through which the quality of medical care can be measured and improved.The present set of measures breaks important ground for performance measurement: First, as opposed to many measures focused on acute disease treatment in the hospital setting, these are focused on primary and secondary prevention in the ambulatory setting. Second, the present measures address not only whether important cardiac risk factors such as hypertension and lipids are “treated” but whether these are “controlled” to target goals. Achieving such control requires both clinicians and their patients to fulfill their respective roles. The clinician must identify a risk, implement appropriate intervention, monitor the response, and then further modify care to reach target goals. The patient too has an important part in reaching success, including keeping appointments, modifying his or her lifestyle, and adhering to prescribed therapies. Finally, these performance measures emphasize patient-focused functional outcomes. They stress the need to assess patient angina and functional symptoms but also to develop treatment plans to improve these outcomes.1. IntroductionThe ACCF/AHA/American Medical Association–Physician Consortium for Performance Improvement (AMA–PCPI) Coronary Artery Disease and Hypertension Performance Measures Writing Committee (the writing committee) was charged with revising the ACCF/AHA/AMA–PCPI Chronic Coronary Artery Disease and Hypertension performance measures sets, which were published in 2005.4,5 The purpose of the present effort is to provide updated measures that can be used to improve care for patients with coronary artery disease (CAD) and hypertension.Recognizing that each measure may impose a burden on providers, the writing committee sought to focus on those areas with the most potential for impact, where there was the strongest consensus about the best practice, and where the likelihood for unintended harm was lowest. Moreover, the group sought as much as possible to keep the measures straightforward, aligned when appropriate with measures developed by others, and clinically sensible, giving the clinician the latitude for judgment about the appropriateness of an intervention when such latitude is justified. Finally, the writing committee sought to adhere to the organizations' previously published methodology for creating performance measures.2,12This updated measure set addresses care in the outpatient setting exclusive of the emergency department. Many guideline-recommended processes were not translated into measures. Decisions about measures to include were based on many factors. Common considerations were the complexity of the guideline recommendations on which the measures were based (potentially making translation difficult) and the feasibility of collecting the required data. This document is intended to supersede the prior CAD and hypertension performance measures set.4,5The members of the writing committee included clinicians specializing in cardiology, internal medicine, family medicine, hospital medicine, and advanced practice nursing, as well as individuals with expertise in performance measure development, implementation, and testing. The writing committee also included patient/consumer representatives and a payer representative. The writing committee had representation from the American Academy of Clinical Endocrinologists, the American Association of Cardiovascular and Pulmonary Rehabilitation, American Academy of Family Physicians, the American College of Emergency Physicians, the American College of Radiology, the American Geriatrics Society, the American Nurses Association, the American Society of Health-System Pharmacists, the Society of Hospital Medicine, and the Society for Thoracic Surgeons.In this updated measure set, the writing committee presents 10 measures, including 2 new measures and 5 revised measures, all of which are intended only for the ambulatory (outpatient) setting. A summary of the new measures set is presented inTable 2.Table 2. 2011 ACCF/AHA/AMA–PCPI Coronary Artery Disease and Hypertension Measurement SetsMeasureDescription*Coronary artery disease 1. Blood pressure controlPercentage of patients aged ≥18 years with a diagnosis of coronary artery disease seen within a 12-month period who have a blood pressure <140/90 mm Hg, OR who have a blood pressure ≥140/90 mm Hg and were prescribed ≥2 antihypertensive medications during the most recent office visit 2. Lipid controlPercentage of patients aged ≥18 years with a diagnosis of coronary artery disease seen within a 12-month period who have an LDL cholesterol result <100 mg/dL, OR who have an LDL cholesterol result ≥100 mg/dL and have a documented plan of care to achieve LDL cholesterol <100 mg/dL, including, at a minimum, the prescription of a statin 3. Symptom and activity assessmentPercentage of patients aged ≥18 years with a diagnosis of coronary artery disease seen within a 12-month period for whom there are documented results of an evaluation of level of activity AND an evaluation of presence or absence of anginal symptoms‡ in the medical record 4. Symptom management†Percentage of patients aged ≥18 years with a diagnosis of coronary artery disease seen within a 12-month period and with results of an evaluation of level of activity, AND with an evaluation of presence or absence of anginal symptoms‡, with appropriate management of anginal symptoms (evaluation of level of activity and symptoms includes no report of anginal symptoms, OR evaluation of level of activity and symptoms includes report of anginal symptoms, and a plan of care is documented to achieve control of anginal symptoms) 5. Tobacco use: screening, cessation, and interventionPercentage of patients aged ≥18 years with a diagnosis of coronary artery disease seen within a 12-month period who were screened for tobacco use AND received tobacco-cessation counseling if identified as tobacco users 6. Antiplatelet therapyPercentage of patients aged ≥18 years with a diagnosis of coronary artery disease seen within a 12-month period who were prescribed aspirin or clopidogrel 7. Beta-blocker therapy: prior myocardial infarction or left ventricular systolic dysfunctionPercentage of patients aged ≥18 years with a diagnosis of coronary artery disease seen within a 12-month period who also have prior myocardial infarction or a current or prior LVEF <40% who were prescribed beta-blocker therapy 8. ACE inhibitor/ARB therapy: diabetes or left ventricular systolic dysfunction (LVEF <40%)Percentage of patients aged ≥18 years with a diagnosis of coronary artery disease seen within a 12-month period who also have diabetes or a current or prior LVEF <40% and who were prescribed ACE-inhibitor or ARB therapy 9. Cardiac rehabilitation patient referral from an outpatient setting7,12†All patients evaluated in an outpatient setting who within the previous 12 months have experienced an acute myocardial infarction, coronary artery bypass graft surgery, PCI, cardiac valve surgery, or cardiac transplantation, or who have chronic stable angina and have not already participated in an early outpatient CR or secondary prevention program for the qualifying event/diagnosis and are referred to such a programHypertension 1. Blood pressure controlPercentage of patients aged ≥18 years with a diagnosis of hypertension seen within a 12-month period who have a blood pressure <140/90 mm Hg, OR who have a blood pressure ≥140/90 mm Hg and were prescribed ≥2 antihypertensive medications during their most recent office visitACCF indicates American College of Cardiology Foundation; ACE, angiotensin-converting enzyme; AHA, American Heart Association; AMA–PCPI, American Medical Association–Physician Consortium for Performance Improvement; ARB, angiotensin II receptor blocker; CAD, coronary artery disease; CR, cardiac rehabilitation; LDL, low-density lipoprotein; LVEF, left ventricular ejection fraction; and PCI, percutaneous coronary intervention.*Please refer to the complete measures for comprehensive information, including measure exceptions.4a,5a†New measure.‡Includes assessment of anginal equivalents.1.1. Scope of the ProblemCAD and hypertension are major and growing public health problems in the United States. See the ACCF/AHA/AMA–PCPI 2011 chronic stable coronary artery disease4a and hypertension5a performance measurement sets, which are both available on the PCPI Web site at http://www.ama-assn.org/apps/listserv/x-check/qmeasure.cgi?submit=PCPI, for a detailed discussion of the scope of the problem and opportunities for improving the quality of care provided to patients with these conditions.1.2. Disclosure of Relationships With IndustryThe work of the writing committee was sponsored exclusively by the ACCF, the AHA, and the AMA–PCPI, without commercial support. Writing committee members volunteered their time for this effort. Meetings of the writing committee were confidential and attended only by committee members and staff from the ACCF, AHA, AMA–PCPI, The Joint Commission, and the National Committee on Quality Assurance (NCQA) to promote harmonization across similar measure sets, as described further in later sections. Writing committee members were required to declare in writing all relationships with industry relevant to this topic. Less than 50% of the writing committee membership has relationships with industry relevant to this topic, in accordance with standard requirements of the ACCF and AHA. Please see Appendix A for relevant writing committee relationships with industry. In addition, Appendix B includes relevant relationships with industry for all peer reviewers of this document.1.3. Review and EndorsementBetween February 9, 2010, and March 13, 2010, the ACCF/AHA/AMA–PCPI 2011 Performance Measures for Adults With Coronary Artery Disease and the 2011 Performance Measures for Adults With Hypertension underwent a 30-day public comment period. During this time, ACCF, AHA, and AMA–PCPI members, as well as other health professionals and members of the general public, had an opportunity to review and comment on the draft document in advance of its final approval and publication. An official peer and content review of the full document was also conducted, with 2 peer reviewers nominated by the ACCF and 1 reviewer nominated by the AHA. Additional comments were sought from clinical content experts and performance measurement experts.The ACCF/AHA/AMA–PCPI 2011 Performance Measures for Adults With Coronary Artery Disease and Hypertension was adopted by the respective boards of the ACCF and AHA and approved by the AMA–PCPI in January 2011. These measures will be reviewed for currency once annually and updated as needed. They should be considered valid until either updated or rescinded by the ACCF/AHA Task Force on Performance Measures and the AMA–PCPI.2. MethodologyThe development of performance measures involves identification of a set of measures targeted toward a particular patient population, observed over a particular time period. To achieve this goal, the ACCF/AHA Task Force on Performance Measures has outlined and published a methodology of sequential tasks required for the development of process-of-care measures as well as for outcomes measures suitable for public reporting.2,11 In addition, the AMA–PCPI has developed a Work Group Charge that outlines the process steps that should be followed by writing committees developing performance measures.13 The following sections outline how these methodologies were applied by the present writing committee.2.1. Identifying Clinically Important OutcomesTo guide the selection of measures for inclusion in the measure set, the writing committee sought to identify outcomes that are meaningful to patients with CAD or hypertension and the structures or processes recommended by practice guidelines that are most strongly associated with those outcomes. The processes on which measures were based include management of risk factors, identification of effective therapeutic options in eligible patients, and accurate and appropriate evaluation of symptoms to guide treatments. A complete list of the desirable outcomes identified by the writing committee and how they relate to the proposed process measures is included in the measure specifications, which are available on the PCPI Web site at http://www.ama-assn.org/apps/listserv/x-check/qmeasure.cgi?submit=PCPI.4a,5a2.2. Dimensions of CareGiven the multiple measurable domains of providing care, the writing committee identified and explicitly articulated the relevant dimensions of care that should be evaluated. As part of the methodology, each potential performance measure was categorized into its relevant dimension of care (Table 3). Classification into dimensions of care facilitated identification of areas in which evidence was lacking and prevented duplication of measures within the set. Diagnostics, patient education (including prognosis and etiology), treatment, self-management, and monitoring of disease status were selected as the relevant dimensions of care for CAD and hypertension performance measures.Table 3. 2011 ACCF/AHA/AMA–PCPI Coronary Artery Disease and Hypertension Performance Measurement Sets: Dimensions of Care Measures MatrixMeasure NameDiagnosticsPatient Education*TreatmentSelf-Management*Monitoring of Disease StatusCoronary artery disease 1. Blood pressure control✓✓ 2. Lipid control✓✓ 3. Symptom and activity assessment✓ 4. Symptom management✓✓ 5. Tobacco use: screening, cessation, and intervention✓✓✓✓ 6. Antiplatelet therapy✓ 7. Beta-blocker therapy: prior myocardial infarction✓ 8. ACE inhibitor/ARB therapy: diabetes or left ventricular systolic dysfunction (LVEF <40%)✓ 9. Cardiac rehabilitation patient referral from an outpatient setting✓✓Hypertension 1. Blood pressure control✓✓ACCF indicates American College of Cardiology Foundation; ACE, angiotensin-converting enzyme; AHA, American Heart Association; AMA–PCPI, American Medical Association–Physician Consortium for Performance Improvement; ARB, angiotensin II receptor blockers; and LVEF, left ventricular ejection fraction.*Although no current measures exist for this dimension, future development will examine how to address this dimension of care.In addition, to ensure the measure set is as comprehensive as possible, the writing committee also evaluated the potential measures against the Institute of Medicine domains of healthcare quality (safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity).1 While focusing primarily on processes of care, the writing committee also considered measures of structures of care and outcomes for CAD (eg, symptom management and lipid management) and for hypertension (eg, blood pressure control). Although the writing committee does not endorse any particular measure developed by others and believes that all measures should be used to quantify the full spectrum of relevant healthcare dimensions, the measures proposed in this set are intended to complement existing National Quality Forum (NQF)–endorsed CAD outcome measures, such as the HealthPartners optimally managed modifiable cardiac risk factor measure,14 and NQF-endorsed hypertension outcome measures, such as the NCQA hypertension control measure.15,162.3. Literature ReviewThe writing committee developed this revised measurement set on the basis of several clinical practice guidelines and did not perform an independent assessment of the evidence itself. Furthermore, the writing committee followed the methodology specified in the ACC/AHA document on developing process measures2 and in the PCPI position statement on the evidence base required for measures development.17 The practice guidelines and statements that provided the basis for these measures can be seen inTable 4.Table 4. Associated Guidelines and StatementsThird Report of the National Cholesterol Education Program (NCEP), Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III)18The National Institutes of Health: National Heart, Lung, and Blood Institute: National High Blood Pressure Education Program19ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina20Public Health Service: Treating Tobacco Use and Dependence Clinical Practice Guideline 2008 Update21ACC/AHA 2004 Guideline Update for Coronary Artery Bypass Graft Surgery22ACC/AHA 2007 Focused Update of the Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction23ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina and Non–ST-Segment–Elevation Myocardial Infarction24AHA Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update25AHA/SCAI 2007 Focused Update of the Guidelines for Percutaneous Coronary Intervention26ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 Appropriateness Criteria for Stress Echocardiography27ACCF/ASNC Appropriateness Criteria for Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging28ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR Appropriateness Criteria for Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging29ACC indicates American College of Cardiology; ACCF, American College of Cardiology Foundation; ACEP, American College of Emergency Physicians; ACR, American College of Radiology; AHA, American Heart Association; ASE, American Society of Echocardiography; ASNC, American Society of Nuclear Cardiology; NASCI, North American Society for Cardiovascular Imaging; SCAI, Society for Cardiac Angiography and Interventi" @default.
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