In 2007, the Cardiac Care Outcomes Assessment Program (COAP) worked with member hospitals across the region to fully understand the benefits of transparency in supporting collaborative quality improvement efforts. With strong support from physician leadership and high confidence in the Foundation for Health Care Quality (FHCQ) and COAP, hospitals agreed to internal transparency within COAP membership for key metrics—COAP’s Level I, II, and III quality indicators. In 2009, the list of metrics shared among members expanded to include an extensive list of process and patient outcomes, which supported greater collaboration and the identification of best practices. In 2012, COAP member hospitals committed to public reporting of COAP Level I, II, and III metrics, demonstrating a high degree of commitment to improving cardiac care across the region.
The COAP Management Committee, made up of cardiac surgeons and cardiologists from across the region, together with other key stakeholders in cardiac care, identifies and tracks key process and patient outcome measures that serve as indicators for quality care. Metrics selected are high patient impact with significant variation across the region, and are revisited annually. These COAP quality indicators are divided into three levels:
Level I : Measures were chosen as quality standards because, for each indicator, a persistent outlier may signal a serious program deficiency.
Level II: Process and quality measures focus on specific areas of patient management. A pattern of persistent outliers in three or more of these measures may also suggest a serious program deficiency.
Level III: Indicators comprise both new measures that are being tested as well as prior Level II measures that should continue to be encouraged as good practice but which will not be subject to sanctions.