Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

CDA 17-162 – HSR&D Study

New | Current | Completed | DRA | DRE | Portfolios/Projects | Centers | Career Development Projects

CDA 17-162
Peer learning to promote quality and appropriate use of percutaneous coronary intervention
Jacob Appel Doll MD
Seattle, WA
Funding Period: May 2019 - April 2024


Dr. Jacob Doll, MD is a Staff Interventional Cardiologist at the VA Puget Sound Health Care System, Acting Assistant Professor in the University of Washington Department of Medicine, Core Investigator at the Seattle HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, and Assistant Director of the VA Clinical Assessment, Reporting, and Tracking (CART) program. The proposed Career Development Award (CDA) will benefit Veterans by improving the delivery of invasive cardiac care through peer learning strategies, while provide the training and support Dr. Doll needs to become a leader in performance evaluation and feedback and to drive innovation in cardiovascular procedural care. This research will develop and test a peer learning intervention that promotes percutaneous coronary intervention (PCI) care quality. PCI, also known as “stenting,” is a common cardiovascular procedure that can improve survival and quality of life when used appropriately. However, clinical outcomes vary significantly among hospitals and physicians. Nearly all PCI procedures in the US are reported to national registries for quality improvement purposes, including the CART program. Despite this wealth of clinical data and substantial investment of time and resources to PCI quality, physicians who perform PCI are not receiving meaningful feedback about their practice. Improved methods of audit and feedback are needed. Peer learning is a collaborative quality improvement method that provides detailed, personalized, and actionable feedback to clinicians from their colleagues. The performance of unnecessary PCI procedures and the technical quality of procedures are of particular interest to VA. Of elective procedures performed at VA, only 24% are clearly indicated by appropriateness criteria, potentially putting patients at risk without benefit. The nominee for this CDA therefore proposes to design and test a peer learning intervention that promotes PCI quality and appropriate case selection. The specific aims of the proposal are: 1) Identify barriers and facilitators to the use of peer learning through surveys and semi-structured interviews with VA PCI operators and key stakeholders; 2) Develop and refine a peer learning intervention that provides usable and acceptable feedback to PCI operators; and 3) Pilot test a peer learning intervention to assess and improve PCI case selection and technical performance. This research will directly benefit Veterans and the VA system by improving the quality of PCI and increasing the frequency of appropriate PCI, thereby maximizing benefit while avoiding unnecessary procedural risks and costs. It will build on the extensive ongoing investment in the CART program by developing a novel method for promoting clinical practice change. Finally, it will develop methods of peer learning that are broadly applicable to other fields. The research program will lead directly to a multi-site randomized controlled trial and ultimately to the development of a national collaborative peer learning system that promotes physician development and care quality. To achieve his research and career goals, Dr. Doll will acquire additional skills in qualitative methods, implementation science, behavior change interventions, and trial design through coursework and directed study. His research and training plan will be supported by a diverse and well-qualified mentorship team that includes David Au, MD, MS (behavior change interventions, implementation of health programs, clinical trials), Sunil Rao, MD (interventional cardiology care quality, clinical trials, observational research), Robb MacLellan, MD (career development, physician training, quality improvement), and Christian Helfrich, PhD, MPH (implementation science, behavior change interventions). This proposed CDA research, in combination with robust mentorship and training plans, will accelerate Dr. Doll's independence as a physician-scientist and leader in cardiovascular medicine.

NIH Reporter Project Information:


Journal Articles

  1. Morrison J, Plomondon ME, O'Donnell CI, Giri J, Doll JA, Valle JA, Waldo SW. Perceptions of Public and Nonpublic Reporting of Interventional Cardiology Outcomes and Its Impact on Practice: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. Journal of the American Heart Association. 2019 Nov 19; 8(22):e014212.
  2. Doll JA. Quality of life after myocardial infarction: more PROgress needed. Heart (British Cardiac Society). 2019 Nov 7; 106(1):8-9.
  3. Kataruka A, Doll JA, Hira RS. Public Reporting for Cardiac Procedures: Is the Juice Worth the Squeeze? Journal of the American College of Cardiology. 2019 Oct 29; 74(17):2218.
  4. Doll JA, Plomondon ME, Waldo SW. Characteristics of the Quality Improvement Content of Cardiac Catheterization Peer Reviews in the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. JAMA Network Open. 2019 Aug 2; 2(8):e198393.
  5. Rymer JA, Kaltenbach LA, Doll JA, Messenger JC, Peterson ED, Wang TY. Safety of Dual-Antiplatelet Therapy After Myocardial Infarction Among Patients With Chronic Kidney Disease. Journal of the American Heart Association. 2019 May 21; 8(10):e012236.
  6. Doll JA, Jones WS, Lokhnygina Y, Culpepper S, Parks RL, Calhoun C, Au DH, Patel MR. PREPARED Study: A Study of Shared Decision-Making for Coronary Artery Disease. Circulation. Cardiovascular quality and outcomes. 2019 Feb 1; 12(2):e005244.
  7. Doll JA, Hellkamp AS, Thomas L, Fonarow GC, Peterson E, Wang TY. The association of pre- and posthospital medication adherence in myocardial infarction patients. American heart journal. 2019 Feb 1; 208:74-80.
  8. Beatty AL, Doll JA, Schopfer DW, Maynard C, Plomondon ME, Shen H, Whooley MA. Cardiac Rehabilitation Participation and Mortality After Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. Journal of the American Heart Association. 2018 Oct 2; 7(19):e010010.
  9. Wang WT, Hellkamp A, Doll JA, Thomas L, Navar AM, Fonarow GC, Julien HM, Peterson ED, Wang TY. Lipid Testing and Statin Dosing After Acute Myocardial Infarction. Journal of the American Heart Association. 2018 Jan 25; 7(3).
  10. Doll JA, Li S, Chiswell K, Roe MT, Kosiborod M, Scirica BM, Wang TY. Clopidogrel reloading for patients with acute myocardial infarction already on clopidogrel therapy. European heart journal. 2018 Jan 14; 39(3):193-200.

DRA: None at this time.
DRE: None at this time.
Keywords: None at this time.
MeSH Terms: None at this time.

Questions about the HSR&D website? Email the Web Team.

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.