Qualidade e Segurança Assistencial Aplicada à Cardiologia: as contribuições da experiência americana Healthcare Safety and Quality Applied to Cardiology: contributions of the american experience

Despite massive progress in medicine, cardiovascular diseases (CVD) are still the leading causes of morbidity and mortality worldwide, boosting healthcare system costs. Good quality care is directly related to adoption of the best practices as recommended by the guidelines. Evidence indicates that compliance may well lower morbidity and mortality rates and reduce the costs of diseases such as acute myocardial infarction and heart failure. There is much concern in the USA over measuring quality and certifying institutions as a strategy for ongoing improvement in healthcare quality and safety, building up more than a century of experience. Although more recent, this certification process is encompassing more hospitals in Brazil. The quality indicators are selected on the basis of the Clinical Guidelines established by Medical Societies, which are grounded on Evidence-Based Medicine. Especially in the USA, Cardiology Societies were pioneers in establishing guidelines. However, even in cardiology, there are wide variations in the use of these guidelines and consequently an equally wide and unjustified variation in clinical practice that downgrades healthcare quality. This paper offers an overview of the quality and safety movement in the US healthcare system, discussing its impact on medical practice and highlighting current proposals for changes in remuneration for medical activities, also considered as an alternative in Brazil.