BMC2’s Peer Review Process Outlined in Circulation Cardiovascular Quality Outcomes

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Elizabeth Horn

BMC2’s Peer Review Process Outlined in Circulation Cardiovascular Quality Outcomes

“Evaluating Percutaneous Coronary Intervention Safety, Quality, and Appropriateness Across Michigan Using Blinded Cross-Institutional Peer Review” is online ahead of print in Circulation Cardiovascular Quality Outcomes.

While several quality improvement initiatives have focused on the quality gap in percutaneous coronary intervention (PCI), significant variations in quality still exist.

The article authors used the BMC2 Cardiovascular Consortium’s novel blinded peer review system – unique to the consortium – to evaluate PCI quality, safety, and appropriateness across Michigan.

Each year physicians from across the consortium engage in cross-site peer review, providing feedback on anonymized cases performed by colleagues around the State of Michigan.

Consortium physicians also participate in annual internal peer review, providing feedback on cases performed by colleagues at their own hospital. 

Feedback presents an opportunity for quality improvement activities leading to a decreased risk of complications from inappropriately performed procedures, decreased patient costs, decreased risk of readmission, and improved clinical outcomes.

In peer review process, BMC2 randomly selects cases and site coordinators upload the case data. An email with a link to access the case is sent to the physician for review. Physicians complete a survey to report the appropriateness of the cases. Hospitals then get a report about the review.Different case types are reviewed with each new cycle. For this publication, single-vessel PCI cases were randomly selected from BMC2’s 2018 - 2020 registry data. Anonymized angiograms and pertinent case records were uploaded to a secure server. Providers used a standardized peer view form and rated each case on procedural quality, safety, and appropriateness. The appropriateness ratings were then compared between reviewers and registry-based appropriateness criteria.

In 1627 independent peer reviews of 961 cases; the majority (96.4%) of reviewers rated angiogram quality as excellent or adequate.

Reviewers noted a complication or suboptimal result in 11.1% of reviews; 44.0% of these were deemed avoidable.

Most PCI procedures were considered appropriate or may be appropriate, (87.1%) by all those reviewing.

Reviewers were less likely to categorize PCI cases as appropriate compared with registry-based appropriate use criteria definitions (73.1% versus 93.3%).

PCI quality and appropriateness in Michigan is high overall. However, key opportunities to improve care were identified during this review.

Additional work is needed to assess the benefits of expanding this approach across the United States.

First author, Dr. Spehar, was awarded the "Kenneth Stark Research Award for Clinical Investigation” for presenting this abstract during the 2022 Michigan Medicine Department of Internal Medicine Research Symposium. The award recognizes Dr. Spehar’s strong commitment to the advancement of science and hard work above and beyond the rigors of training.

Additional authors are Milan Seth, John F. Collins, Simon R. Dixon, Elizabeth Pielsticker, Daniel Lee, Mark Zainea, Thomas LaLonde, Dilip Aurora, Devraj Sukul, and Hitinder Gurm.

Learn more on PubMed.