VA Hospitals CART Program Provides Quality Oversight Of All VA Heart Cath Labs

Thomas M. Maddox, MD MSc FACC FAHA Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART Program Associate Professor, Department of Medicine, University of Colorado School of MedicineMedicalResearch.com Interview with:
Thomas M. Maddox, MD MSc FACC FAHA
Cardiology, VA Eastern Colorado Health Care System
Associate Director, VA CART Program
Associate Professor, Department of Medicine, University of Colorado School of Medicine

Medical Research: What are the main findings of the study?

Dr. Maddox: We were curious to know if the VA, as a provider of PCI at centers without on-site CT surgery, was providing better access to its veterans without compromising their safety.  We were pleased to find that there was evidence of better access, with patients reducing their drive time to PCI facilities by, on average, 90 minutes.  In addition, there was no compromised safety.  Rates of both peri-procedural and 1-year adverse outcomes were low and no different between centers with and without on-site CT surgery.


Medical Research: Were any of the findings unexpected?

Dr. Maddox: None were unexpected, but the questions about access and safety were unknown, so it was gratifying to see the results.  We were happy to see that access improved without causing any harm.  We were also pleased to see that the VA CART program – a national clinical quality program with oversight of all VA cath labs – appears to be providing effective quality supervision.  We believe that quality oversight programs like CART may be an example of how effective quality management for cardiac services can be provided nationally and internationally.

Medical Research: What should clinicians and patients take away from your report?

Dr. Maddox: Clinicians and patients in the VA system should be comforted by the knowledge that they will receive safe care in any of the VA cath labs that provide PCI.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Maddox: Keeping a close eye on outcomes in all labs going forward will be important.  Fortunately, the CART program is designed to do just that.  We should also explore what specific factors are leading to such a safe environment.  Is it highly trained interventional cardiologists?  Good patient selection?  Excellent cath lab staff?  By answering these sorts of questions, we can make sure that all cath labs, both within and outside of the VA, have the essential elements to provide safe and effective cardiac care.

Citation:
Patient Access and 1-Year Outcomes of Percutaneous Coronary Intervention Facilities with and without On-Site Cardiothoracic Surgery: Insights from the VA CART Program

Thomas M. Maddox, Maggie A. Stanislawski, Colin O’Donnell, Mary E. Plomondon, Steven M. Bradley, P. Michael Ho, Thomas T. Tsai, Adhir R. Shroff, Bernadette Speiser, Robert J. Jesse, and John S. Rumsfeld

Circulation. 2014;CIRCULATIONAHA.114.009713published online before print September 4 2014, doi:10.1161/CIRCULATIONAHA.114.009713

 

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