OR12-4
Peer Review of Percutaneous Coronary Intervention Operator Performance
Presenter
Jacob A. Doll, M.D., The University of Washington, Seattle, WA
Jacob A. Doll, M.D.1, Annika Hebbe, MS2, Carol Simons, BA3, Elliot Stein, MD4, Sunil V. Rao, MD, FSCAI5, Stephen W Waldo, MD6, Christian Helfrich, PhD3 and David Au, MD3, (1)The University of Washington, Seattle, WA, (2)Rocky Mountain Veterans Affairs Medical Center, Aurora, CO, (3)VA Puget Sound Health Care System, Seattle, WA, (4)University of Washington, Seattle, WA, (5)NYU Langone Health, Chapel Hill, NC, (6)University of Colorado Anschutz Medical Campus, Denver, CO
Keywords: Complications, Coronary, Quality and Training and Professional Development
Background:
Peer review is often used to assess percutaneous coronary intervention (PCI) operator competency, but there are no studies testing the validity of case-based peer review for PCI performance assessment.
Methods:
We recruited operators in Veterans Affairs (VA) practice to provide cases for review. Ten expert reviewers performed blinded case reviews such that each was reviewed twice. Cases were rated on a 1-5 scale (5 is best) for 6 care domains (appropriateness, lesion suitability, strategy, technical performance, outcome, and documentation) with a performance score calculated as the average of all domains. Separately, reviewers determined if the standard of care was met. Inter-observer reliability was calculated using interclass correlation coefficient (ICC). We examined procedural and 30-day outcomes for all PCIs performed by these operators from 2019-2022 when stratified in tertiles by performance score.
Results:
Of 65 cases provided by 13 operators, the mean performance score was 3.90 (SD 0.78) out of 5. The ICC was 0.53, indicating moderate inter-observer agreement. Reviewers frequently disagreed about whether the standard of care was met. Among 3390 cases performed by the reviewed operators, higher peer review rating was associated with lower rates of procedural complications and 30-day MACE (Figure).
Conclusions:
Case-based PCI peer review identifies variation in physician performance that is correlated with patient outcomes. However, sub-optimal inter-observer reliability raises concerns about the use of peer review as a sole measure of operator competency.
