Quality improvement in heart rhythm care: the path forward

The drastic changes in the American health-care environment have brought forward several major quality improvement initiatives including performance measurement, the demand for transparency to be implemented, at least in part, through public reporting, and the need to demonstrate appropriate use of interventions. Despite the great potential of these initiatives to improve the quality of health care and patient outcomes, the average clinician has not been engaged in or educated about these initiatives. This is particularly true of specialists like electrophysiologists. Given that participation in these initiatives will become mandatory in the next few years, it is critically important to prepare our community for these programs. To that end, electrophysiologists should be educated about the potential strengths and pitfalls of these quality improvement programs, and they should be engaged more effectively in the development and testing of such programs. Indeed, electrophysiologists face unique challenges that deserve attention. Some of these challenges relate to the scarcity of performance measures that are specific to heart rhythm care and the scarcity of registries that could be used for performance measures and public reporting. This article provides an overview of performance measures and public reporting, the role of registries in quality improvement, and appropriate use criteria. It then concludes with recommendations regarding the proper implementation of these quality improvement initiatives to ensure a high likelihood of success.