[Guides and standards: Quality indicators for the care and services provided in long-term left ventricular assist device implantation programs]
Tréfier A, Boothroyd L
Record ID 32018013455
French
Original Title:
Indicateurs de la qualité des soins et services dispensés au sein des programmes d’implantation de dispositifs d’assistance ventriculaire gauche de longue durée
Authors' objectives:
Managing heart failure involves different complex procedures, which depend on the
severity and the etiology of the condition, as well as the patient’s characteristics and
preferences. In the advanced stage of the disease, when the patient experiences severe
symptoms at rest and becomes refractory to pharmacological or surgical treatment, the
short-term life expectancy is at risk and a heart transplant remains the treatment of
choice. For patients waiting for a heart transplant and for those who are not candidates
for a transplant, a long-term left ventricular assist device (VAD) is one of the available
treatments contributing to survival under acceptable conditions. VAD implantation is a
complex treatment option requiring a considerable amount of sophisticated infrastructure,
and it involves significant costs [INESSS, 2014]. Currently, in Québec, this procedure is
performed in three programs: at the Institut de Cardiologie de Montréal, the Institut
universitaire de cardiologie et de pneumologie de Québec and Centre universitaire de
santé McGill.
At the request of the Ministère de la Santé et des Services sociaux (MSSS), INESSS
has, since 2011, carried out a series of projects on VADs, including a report on the
advisability of recognizing the implantable VAD as a bridge or alternative treatment option
to heart transplantation [INESSS, 2012], a first report on the state of the practice in
Québec [INESSS, 2014], practice standards [INESSS, 2016] and a second state-of-thepractice report covering the years 2010 to 2017 [INESSS, 2021]. In 2023, the MSSS
asked INESSS to draw up a list of indicators for assessing the quality of the care and
services provided in Quebec’s VAD programs for adults with advanced heart failure.
Authors' results and conclusions:
RESULTS : Upon completion of the ranking process, three lists of indicators were proposed (from the
most to the least priority):
• Priority list 1: Composed of 10 indicators with a score of 80% or higher, no
negative scores in the four dimensions and the highest selection frequency by the
advisory committee’s members.
• Priority list 2: Composed of 5 indicators with a score of 80% or higher, no negative
scores in the four dimensions, but not selected as priority by the advisory
committee’s members.
• Priority list 3: Composed of 5 indicators with a score of 80% or higher and at least
one negative score in one of the four dimensions. CONCLUSION: The responses and comments gathered during the two consultations demonstrate a
heterogeneity of practices and viewpoints regarding a certain number of the proposed
indicators. This diversity was particularly evident for the data collection feasibility issues.
The exercise carried out nonetheless led to a high degree of approval for the selected
quality indicators.
The list of proposed indicators is another in a series of projects and standards developed
by INESSS over the past few years to support the harmonization and optimization of
structures and processes in VAD programs and to optimize the quality and safety of care
and services provided to patients with advanced heart failure in Quebec.
Authors' methods:
Based on a rapid and targeted update of the scientific literature and guidelines issued by
learned society, as well as on the standards for VAD programs published by INESSS in
2016, 28 potential care and service quality indicators were identified and sorted into three
categories using the Donabedian model [2003]: structure indicators, process indicators
and clinical outcome indicators. An advisory committee composed of healthcare
professionals from the three VAD implantation centres in Quebec and from various
disciplines assessed and ranked the potential indicators using an adapted approach of
the Delphi method based on two consecutive online questionnaires. Each indicator was
evaluated according to four dimensions: importance, scientific acceptability,
measurement feasibility and overall assessment. • As a first step, the overall assessment scores were analyzed. Only indicators with
a score greater than or equal to the arbitrary selection threshold of 80% were
chosen [Tu et al., 2013].
• As a second step, to facilitate the implementation of indicators in the field, a first
ranking was performed by the project team. This was based on selecting
indicators that reached the 80% threshold and received no negative scores in the
four dimensions. This ranking reduced the initial list to 15 indicators.
• From this list, committee members were invited to conduct a second ranking
exercise to select the 10 indicators they considered the most important, keeping
at least one indicator for each category (i.e., structure, processes and clinical
outcomes).
Details
Project Status:
Completed
Year Published:
2024
English language abstract:
An English language summary is available
Publication Type:
Other
Country:
Canada
Province:
Quebec
MeSH Terms
- Heart Failure
- Heart-Assist Devices
- Practice Guideline
- Standard of Care
- Quality of Health Care
Contact
Organisation Name:
Institut national d'excellence en sante et en services sociaux
Contact Address:
L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name:
demande@inesss.qc.ca
Contact Email:
demande@inesss.qc.ca
Copyright:
L'Institut national d'excellence en sante et en services sociaux (INESSS)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.