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Invasive Cardiac Services Advisory Committee Meeting 1

Invasive Cardiac Services Advisory Committee Meeting 1. Madeleine Biondolillo, MD Director, Bureau of Health Care Safety and Quality Interim Associate Commission Department of Public Health October 25, 2013. Agenda. Welcome and Introductions

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Invasive Cardiac Services Advisory Committee Meeting 1

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  1. Invasive Cardiac Services Advisory Committee Meeting 1 Madeleine Biondolillo, MD Director, Bureau of Health Care Safety and Quality Interim Associate Commission Department of Public Health October 25, 2013

  2. Agenda • Welcome and Introductions • Open Meeting Law – Carol Balulescu, Office of General Counsel • Operating Rules   • Frequency of Meetings • Overview of Topics to be Addressed by ICSAC: • Oversight of Hospitals Providing Non-Emergency Percutaneous Coronary Interventions (PCIs) • PCI volume minimums (hospital and operator) • Additional hospital providers of primary and non-emergency PCI • Next Steps

  3. Open Meeting Law • Signed forms are due to Nancy Murphy by November 8, 2013: • Read the required information • Sign the form provided at today’s meeting • Mail the hard copy or e-mail a scanned copy to Nancy Murphy Hard Copies: Department of Public Health c/o Nancy Murphy 99 Chauncy Street, 11th Floor Boston, MA 02111 Email: Nancy.Murphy2@massmail.state.ma.us

  4. Operating Rules 1. Advisory Committee meetings will not include a conference call line for members who are unable to attend the meeting in person. 2. If a member is unable to attend a meeting in person, the member may send a designee in his or her place, provided that the chair has been notified in writing in advance of the meeting. • A member may only designate one person as his or her representative. If that person is unable to attend a meeting on the member’s behalf, the member may not send another designee. • Designees may not vote. 3. Votingwill be done by consensus, rather than roll call. 4. A member of the public can only participate in the discussion if the Chair authorizes that person to speak.

  5. Frequency of Meetings • The ICSAC will meet at least yearly • Sub-groups by topic to meet more frequently

  6. Guiding Principles for the ICSAC

  7. Overviewof Topics to be Addressed by ICSAC • Model for Oversight / Monitoring • Volume Minimums • Expansion to other facilities

  8. PCI Oversight

  9. PCI Oversight Goal: comprehensive, proactive, uniform requirements for all providers

  10. PCI Oversight Challenges with Existing System for Oversight • Administrative burden on providers to report varying data elements to multiple programs • Data on patient outcomes received weeks to months after procedure performed, forcing DPH to be reactive rather than proactive • Limited ability to track compliance with explicit program requirements (e.g., inclusion/exclusion criteria) • Insufficient peer review: • Recruiting reviewers for annual Mass-DAC chart adjudication • To ensure compliance with inclusion/exclusion criteria • To ensure appropriate use • Requirements, and therefore data, vary significantly based on hospital characteristics

  11. PCI Oversight • Feedback & discussion on PCI Oversight

  12. Volume Minimums • All but primary angioplasty minimum required by DPH cardiac catheterization regulations • MASS COMM Hospitals were not required to meet PCI facility minimum (200) during their participation in the trial

  13. Volume Minimums Considerations • Should operator experience affect compliance with volume minimums? • Should facility experience affect compliance with volume minimums? • What steps could be taken when an operator fails to meet his or her volume minimums? • What steps could be taken when a facility fails to meet its volume minimums?

  14. Expansion To Other Facilities • Massachusetts hospitals with cardiac catheterization services:

  15. Expansion To Other Facilities • Drive time < 60 minutes to emergency-PCI capable programs considered standard for access, leading to improved patient outcomes. • Massachusetts hospitals with emergency PCI capability:

  16. Expansion To Other Facilities Considerations • Ensuring that all hospitals are able to meet required volume minimums • Ensuring that operators follow Appropriate Use Criteria in selecting patients Feedback & discussion on expansion

  17. Next Steps • Formation of a sub-committee dedicated to designing system of PCI oversight: • Sub-committee will have more regular meetings • Members will be expected to attend meetings every 2 months • Clinical and/or data expertise preferred • If you wish to participate on the sub-committee, please e-mail Nancy Murphy at Nancy.Murphy2@massmail.state.ma.us • Sub-committee membership will be capped at 7. If more than 7 people express interest, the Chair will determine the membership. • Next meeting will focus on recommendations on oversight from the subcommittee

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