For these reasons, the writing committee did not include any outcome measures related to restenosis or thrombosis. 6.3. Structural Measures Two additional structural measures related to use of standard- ized protocols were carefully considered by the writing com- mittee. However, these structural measures were determined to be inappropriate for inclusion in the measure set at the pres- ent time. In both cases, use of protocols has been advocated as a way to potentially mitigate risk for patients in developing complications from PCI. First, given the high potential for morbidity and mortality associated with use of antiplatelet and anticoagulation therapy, the writing committee considered a measure to assess use of a standardized protocol for these agents. However, despite their extensive use of these protocols, there is scant evidence to link their use of a protocol to improved patient outcomes. Dosing guidelines exist for specific agents; however, there is a wide range of variability even in the guidelines to account for important clinical considerations, including adjustments for renal impairment, concomitant warfarin anticoagulation, and other clinical factors. Thus, the writing committee decided that the proposed measure offered little added value to quality care assessment at the present time, given the complexity required for its effective implementation. The writing committee does encourage development and implementation of protocols for antiplatelet and anticoagulant therapy as appropriate on a local basis, and reconsideration of this measure might occur in future iterations of this measure set as the evidence base evolves. Second, the writing committee considered use of a protocol for managing contrast-related nephropathy before and during Nallamothu et al ACC/AHA/SCAI/AMA-PCPI/NCQA 2013 PCI Performance Measure 939 PCI but decided that the evidence base is not substantive enough to support inclusion of such a measure at the present time. 