Quality indicators for cardiac care: National standards in a community context

Objective: Public reporting of health data is well established in the United States and in the United Kingdom, and is assumed to promote better health care through informed choice by consumers. To be successful, reporting systems must have the support of physicians, but their opinions have been mixed. The purpose of this study was to explore with practising physicians the perceived usefulness of, and barriers to use of, quality indicators in the care of acute myocardial infarction and congestive heart failure, and the contexts in which these issues arise. Methods: Six focus groups were conducted in small-, medium- and large-sized communities in two provinces in Canada. Subjects were family physicians, emergency physicians, internists and cardiologists. Data were analysed inductively. Results: Our participants were generally supportive of the quality indicators, with concerns expressed regarding interpretation of data from measures created by 'experts' but applied in the context of community hospitals and community-based practice. Content analysis disclosed that a majority of the indicators was acceptable; few were outright unacceptable. Inductive analysis revealed two contextual concerns: issues arising from the structure and organization of the health care system, such as equitable access to health care resources and discontinuity or fragmentation of the system, and patient-related issues, such as compliance with medications post-discharge and costs of medications. Conclusions: There is general support for this set of quality indicators, with the caveat that data should be carefully interpreted in the context of each community in which they are applied.