Aortic Stenosis Gradients and a Case for Quality Improvement

Paul Batalden,1 a world-renowned quality expert, is quoted to have said “Every system is perfectly designed to get the results it gets.” Implied from his quote is when different results are desired the processes of care that make up the system producing those results need to change. Too often in health care today we struggle with process deficiencies or inadequacies that negatively affect the care patients receive. Commonly, providers and other members of the multidisciplinary team do not have a framework or methodology to address those deficiencies. In academic settings, providers will often turn to research to identify solutions to address them. However, this approach comes at a cost. Research requires heavy resource investment and its measurement approach is unrealistic for improvement purposes. Research’s timeline is not conducive to addressing quality problems in a timely manner nor does it take into consideration the sustainability of solutions identified. Instead, a different approach is needed for improvement work. An approach that allows for a logical and practical method in identifying solutions that work in actual clinical settings and leads to the true north of realizing sustained improvement. If you will, the approach needed is one that works in vivo not in vitro.See Article by Samad et al In their article in this issue of Circulation: Cardiovascular Imaging , Samad et al2 have successfully demonstrated how continuous quality improvement (QI) can be applied to address an important clinical issue, namely the variation in echocardiographic determination of aortic stenosis (AS) gradients that leads to overtesting via cardiac catheterization. Using continuous quality improvement methodology, they were able to identify modifications in their echocardiography approach that improved the agreement between cath- and echo-derived mean AS gradients. The subsequent improvement in correlation leads to a decrease in unnecessary referrals for evaluation by invasive valve …