Public Reporting of Percutaneous Coronary Intervention Outcomes (original) (raw)
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Journal of the American College of Cardiology, 2019
Background: Public reporting of percutaneous coronary intervention (PCI) outcomes is intended to improve quality and increase transparency. However, evidence suggests these objectives have not been realized and that reporting may encourage risk aversive physician behavior to the detriment of critically-ill patients. Given its questionable benefit, understanding the financial and administrative burden of public reporting requirements for physicians and institutions is critically important. Methods: A standardized survey was developed that assessed the costs and burden of public reporting requirements. The survey was administered electronically to cardiac catheterization laboratory directors in Massachusetts. Results: All 24 cardiac catheterizations laboratories performing PCI in Massachusetts were contacted (100%) and 13 responded (54.2%). The median estimated annual cost of public reporting was 100,000−100,000-100,000−200,000 (Figure). The estimated total cost among all respondents was $1,723,000 per year. On a scale of 1 (low) to 10 (high) for administrative burden associated with meeting reporting requirements, the median burden was 7. Two-thirds of respondents felt that administrative burden outweighed the benefits of reporting. Conclusion: Public reporting for PCI imposes significant cost and administrative burden to health care institutions in Massachusetts without evidence that it improves patient care.
JACC: Cardiovascular Interventions, 2016
Assessment of clinical outcomes such as 30-day mortality following coronary revascularization procedures has historically been used to spur quality improvement programs. Public reporting of risk-adjusted outcomes is already mandated in several states, and proposals to further expand public reporting have been put forward as a means of increasing transparency and potentially incentivizing high quality care. However, for public reporting of outcomes to be considered a useful surrogate of procedural quality of care, several prerequisites must be met. First, the reporting measure must be truly representative of the quality of the procedure itself, rather than be dominated by other underlying factors, such as the overall level of illness of a patient. Second, to foster comparisons among physicians and institutions, the metric requires accurate ascertainment of and adjustment for differences in patient risk profiles. This is particularly relevant for high-risk clinical patient scenarios. Finally, the potential deleterious consequences of public reporting of a quality metric should be considered prior to expanding the use of public reporting more broadly. In this viewpoint, the authors review in particular the characterization of high-risk patients currently treated by percutaneous coronary interventional procedures, assessing the adequacy of clinical risk models used in this population. They then expand upon the limitations of 30-day mortality as a quality metric for percutaneous coronary intervention, addressing the strengths and limitations of this metric, as well as offering suggestions to enhance its future use in public reporting.
The California Cardiac Surgery and Intervention Project: evolution of a public reporting program
The American …, 2006
Mandatory public reporting of cardiac surgery outcomes in California was instituted in 2003. To study the impact of the program, the outcomes of coronary artery bypass graft (CABG), valve, and percutaneous coronary intervention (PCI) procedures performed after January 1, 2003 were compared with previous years using the Patient Discharge Database (PDD) of the Office of Statewide Health Planning and Development. Risk-adjusted in-hospital mortality for CABG, CABG plus valve or aneurysm, and valve procedures decreased during 2003 and 2004 compared with 1998 through 2002, and PCI mortality remained unchanged. The average annual procedural volume per hospital decreased 25 per cent (232% ± 205% to 173% ± 157%) for CABG and 18 per cent (310% ± 278% to 253% ± 235%) for all cardiac surgeries, whereas PCI increased 12 per cent (433% ± 277% to 492% ± 356%). During 2003 and 2004, less than one-half of the 120 hospitals performed 200 or more cardiac surgeries per year, and only 25 performed 300 or more. Higher CABG mortality was observed primarily in low-volume programs, but the relationship of volume to risk-adjusted mortality was not significant for any surgical group or for PCI. Identification of outlier status was facilitated by use of 30-day posthospital outcomes (death or reoperation) in addition to in-hospital mortality. This study suggests that the introduction of a mandatory cardiac surgery reporting program in California was associated with improved outcomes.
Percutaneous Coronary Intervention Utilization and Appropriateness across the United States
PloS one, 2015
Substantial geographic variation exists in percutaneous coronary intervention (PCI) use across the United States. It is unclear the extent to which high PCI utilization can be explained by PCI for inappropriate indications. The objective of this study was to examine the relationship between PCI rates across regional healthcare markets utilizing hospital referral regions (HRRs) and PCI appropriateness. The number of PCI procedures in each HRR was obtained from the 2010 100% Medicare limited data set. HRRs were divided into quintiles of PCI utilization with increasing rates of utilization progressing to quintile 5. NCDR CathPCI Registry® data were used to evaluate patient characteristics, appropriate use criteria (AUC), and outcomes across the HRR quintiles defined by PCI utilization with the study population restricted to HRRs where ≥ 80% of the PCIs were performed at institutions participating in the registry. PCI appropriateness was defined using 2012 AUC by the American College of...