Snapshot of current carotid artery stenting practice and accreditation in the USA

[摘要] Objective The aim of this exploratory study was tocompare the performance of carotid artery stenting(CAS) best practices between Intersocietal AccreditationCommission (IAC) accredited facilities and non-accreditedfacilities certified by the Centers for Medicare andMedicaid Services (CMS).Methods A random, anonymous survey was sent toCMS and IAC accredited facilities querying facility routineperformance of 16 CAS procedure components found inpublished guidelines and utilised during clinical trials.Results There were 28 responses (response rate=17%).Significant differences were found between the CMSand the IAC facilities for four of 16 procedure measures:determination of modified Rankin Scale score priorto stenting (p=0.012, 95%CI 20% to 80%), accuratemeasurement of per cent stenosis using electroniccallipers (p=0.005, 95%CI 24% to 84%), confirmation ofanticoagulation with activated clotting time greater than250 s prior to crossing the lesion (p=0.03, 95%CI 7% to69%), and comparison of facility outcomes to acceptedbenchmarks for stroke and death (p=0.03, 95%CI 7% to69%). Overall, IAC facilities performed all 16 proceduresmore frequently (97%) than CMS facilities (66%) (p<0.001,95%CI 24% to 36%).Conclusions Although the sample size was small, theresults demonstrated IAC accredited facilities are morelikely to follow best practices, to use quantitative toolsto select appropriate patients, and quantitively measurepatient-centred clinical outcomes compared with CMScertified facilities. The findings raise the question as to thevalue of CMS certification versus IAC accreditation as arequirement for reimbursement.

[学科分类] 药学