Quality is not an act, it is a habit.

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Even though the Ancient Greek philosopher Aristotle was most certainly not speaking to the clinical practice of healthcare, his ideology still applies in that space. Quality care cannot be achieved through properly performing procedures on a one-time basis or within siloed settings, but instead on a repetitious basis, which requires constant re-evaluations.

These assessments and clinical studies of cardiovascular care within hospital and outpatient settings have become more common during the healthcare debate, and will continue to proliferate as quality metrics are tied to incentives and reimbursements.

A study that appeared in JAMA assessed whether publicly released hospital report cards that rely heavily on the evaluation of hospitals improve patient care. The researchers, which studied acute cardiac care to patients with acute MI and congestive heart failure at 86 facilities, found the dissemination of this information did not significantly improve outcomes with these conditions.

The recent literature has suggested that high volume PCI hospitals will lead to the best quality of care for MI patients. However, a separate JAMA study found that there appears to be no significant difference in outcomes, such as length of hospital stay or risk of death, even though those hospitals that perform a higher number of angioplasties are more likely to follow evidence-based guidelines and have shorter procedure times.

In a different area of cardiovascular care that shows room for quality improvement, a CPR survey, released during the American Heart Association conference last week, found that there is a global need to improve the performance of healthcare professionals in using CPR to ward off sudden cardiac death.

Finally, researchers also discovered a need to improve the quality of post-marketing safety studies, after reviewing the 30 randomized, placebo-controlled trials of Vioxx. They suggested that evidence of cardiovascular risks associated with taking the popular, nonsteroidal anti-inflammatory drug could have been identified nearly four years before Merck pulled it off the market.

In seeking to change the practices of healthcare to achieve better quality, it may also serve to improve the individual, as Aristotle suggests: “We are what we repeatedly do."

On these topics, or any others, please feel free to contact me.

Justine Cadet