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Clinical Assessment Reporting and Tracking System for Cath Labs (CART-CL)

December 28, 2021


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VA’s Quality Enhancement Research Initiative (QUERI) is a unique quality-improvement program designed to use the expertise the department has developed in health services research to improve the care VA provides to Veterans. One of QUERI’s most significant projects has been to develop and implement a national VA reporting system, data repository, and quality improvement program for procedures performed in the department’s 77 cardiac catheterization laboratories, known as cath labs. The system is known throughout VA as the Clinical Assessment Reporting and Tracking System for Cath Labs (CART-CL).

Cardiac catheterization is a procedure used to diagnose and treat cardiovascular conditions. During the procedure, a long, thin tube called a catheter is inserted in an artery or vein in the groin, neck, or arm, and is threaded through the blood vessels to the heart. The procedure allows cardiologists to investigate what’s going on in the heart, or to open blocked arteries that impede blood flow.

The CART-CL project began in 2003, in response to a study conducted by Harvard Medical School. The study compared VA and Medicare patients who had suffered heart attacks between 1997 and 1999. It found VA heart attack patients traveled further than Medicare patients to reach the hospital; they were much less likely to be admitted to a hospital capable of performing a cardiac catheterization procedure; and nearly 35% of these men and women under VA care died within a year, compared to about 31% of Medicare patients.

The program is one of VA’s ways of improving care for heart attack patients resulting from the Harvard study. The department also worked to improve Veterans’ access to top-notch care, established performance measures to measure the performance of VA hospitals, and reviewed the ways individual patients with heart attacks and unstable angina had been treated in the past.

Today, the CART program has developed three analytic tools: VA Bleeding Risk, which estimates the risk of bleeding during a percutaneous coronary intervention based on the access site for the procedure; the VA Syntax Score, which summarizes the anatomic complexity of coronary artery disease and the associated risk of major adverse cardiovascular events; and the VA Mortality Model, which estimates the risk of death within 30 days of a percutaneous coronary intervention.

CART-CL requires every VA cath lab to provide the same kind of documentation on all catheterization procedures the system undertakes, and on the health of patients before and after the procedure. It allows VA to make good comparisons of results among cath labs throughout the nation. Those with the highest levels of quality share their best practices, with other VA hospitals. Those who rank lowest are reviewed to ensure they are performing their procedures correctly or if there are problems that can be identified and corrected. VA now also compares its results with non-VA cath labs throughout the nation, using standards developed by the American College of Cardiology’s National Cardiovascular Data Registry.

CART-CL has been successfully implemented in all 77 VA cath labs, and is regarded as a model for clinical application development and implementation within VA’s health care system and throughout the nation.

Selected publications:

Leading causes of cardiovascular hospitalization in 8.45 million US Veterans. Krishnamurthi N, Francis J, Fihn SD, Meyer CS, Whooley MA. PLoS One. 2018 Mar 22;13(3):e0193996.

Strategies from a nationwide health information technology implementation: the VA CART story. Box T, McDonnell M, Helfrich C, Jesse RL, Fihn SD, Rumsfeld JS. J Gen Intern Med. 2010 Jan;25(Suppl 1):72–76.

VA implements system-wide tracking system for cardiac catheterization. VA Health Services Research & Development website, Sept. 7, 2018.

The Clinical Assessment Reporting and Tracking (CART) program. VA Office of Quality and Patient Safety website.

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