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Quality in interventional cardiology: towards the future.

Interventional cardiology is an example of a medical field in which rapid technological advances have taken place over a short period of time. In the 26 years since the inception of interventional cardiology, there has been an enormous increase in the volume of cases and the number of operators and sites performing coronary angioplasty. Coupled with this, in the last decade we have witnessed tremendous developments in the techniques, materials and adjunctive therapy associated with percutaneous coronary intervention. Health care interventions are intended to benefit patients, but they can also cause harm. The complex combination of processes, technologies and human interaction that constitutes the modern health care delivery system can bring significant benefits. However, it also involves an inevitable risk of adverse events that can, and too often do, happen. The Joint Commission on Accreditation of Healthcare Organizations has defined quality in health care as "the degree to which patient care services increase the probability of desired patient outcomes and reduce the possibility of undesired outcomes, given the current state of knowledge." The establishment of quality standards based on patient outcomes data is a rational means of differentiating the quality of health care in the marketplace. Institutional variation in patients' baseline clinical risks precludes the direct comparison of outcomes across institutions. The application of risk adjustment methodology to account for patient differences in these treatment outcomes is imperative for legitimate comparison of institutional results in the modern era of cardiovascular intervention. The aim of this paper is promote reflection on the importance of quality in interventional cardiology and, simultaneously, to emphasize the role of health professionals in this regard, in daily practice and through their investigations. Another aim is encourage the inclusion of risk adjustment methodology to account for patient differences, and consequently, to make an accurate assessment of the results obtained by different operators and institutions.