TY - JOUR
T1 - State mandated public reporting and outcomes of percutaneous coronary intervention in the United States
AU - Cavender, Matthew A.
AU - Joynt, Karen E.
AU - Parzynski, Craig S.
AU - Resnic, Frederick S.
AU - Rumsfeld, John S.
AU - Moscucci, Mauro
AU - Masoudi, Frederick A.
AU - Curtis, Jeptha P.
AU - Peterson, Eric D.
AU - Gurm, Hitinder S.
N1 - Funding Information:
This research was supported by the American College of Cardiology Foundation's National Cardiovascular Data Registry and by grant U01 HL105270-03 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute in Bethesda, Maryland. The views expressed in this manuscript represent those of the authors and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com . Drs Cavender, Joynt, Resnic, Parzynski, and Moscucci report no conflicts of interest. Dr. Rumsfeld reports the following relationship: NCDR (Chief Science Officer). Dr. Masoudi reports the following relationships: NCDR (Senior Medical Officer), Oklahoma Foundation for Medical Quality (contract). Dr. Curtis reports the following relationships: ACC-NCDR (salary support, significant) and CMS (salary support, significant). Dr. Peterson reports the following relationship: NCDR CathPCI Registry (Research grant, principal investigator for data co-ordinating center). Dr. Gurm reports the following relationships: National Institutes of Health and AHRQ (research support).
Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Public reporting has been proposed as a strategy to improve health care quality. Percutaneous coronary interventions (PCIs) performed in the United States from July 1, 2009, to June 30, 2011, included in the CathPCI Registry were identified (n = 1,340,213). Patient characteristics and predicted and observed in-hospital mortality were compared between patients treated with PCI in states with mandated public reporting (Massachusetts, New York, Pennsylvania) and states without mandated public reporting. Most PCIs occurred in states without mandatory public reporting (88%, n = 1,184,544). Relative to patients treated in nonpublic reporting states, those who underwent PCI in public reporting states had similar predicted in-hospital mortality (1.39% vs 1.37%, p = 0.17) but lower observed in-hospital mortality (1.19% vs 1.41%, adjusted odds ratio [ORadj] 0.80; 95% confidence interval [CI] 0.74, 0.88; p <0.001). In patients for whom outcomes were available at 180 days, the differences in mortality persisted (4.6% vs 5.4%, ORadj 0.85, 95% CI 0.79 to 0.92, p <0.001), whereas there was no difference in myocardial infarction (ORadj 0.97, 95% CI 0.89 to 1.07) or revascularization (ORadj 1.05, 95% CI 0.92 to 1.20). Hospital readmissions were increased at 180 days in patients who underwent PCI in public reporting states (ORadj 1.08, 95% CI 1.03 to 1.12, p = 0.001). In conclusion, patients who underwent PCI in states with mandated public reporting of outcomes had similar predicted risks but significantly lower observed risks of death during hospitalization and in the 6 months after PCI. These findings support considering public reporting as a potential strategy for improving outcomes of patients who underwent PCI although further studies are warranted to delineate the reasons for these differences.
AB - Public reporting has been proposed as a strategy to improve health care quality. Percutaneous coronary interventions (PCIs) performed in the United States from July 1, 2009, to June 30, 2011, included in the CathPCI Registry were identified (n = 1,340,213). Patient characteristics and predicted and observed in-hospital mortality were compared between patients treated with PCI in states with mandated public reporting (Massachusetts, New York, Pennsylvania) and states without mandated public reporting. Most PCIs occurred in states without mandatory public reporting (88%, n = 1,184,544). Relative to patients treated in nonpublic reporting states, those who underwent PCI in public reporting states had similar predicted in-hospital mortality (1.39% vs 1.37%, p = 0.17) but lower observed in-hospital mortality (1.19% vs 1.41%, adjusted odds ratio [ORadj] 0.80; 95% confidence interval [CI] 0.74, 0.88; p <0.001). In patients for whom outcomes were available at 180 days, the differences in mortality persisted (4.6% vs 5.4%, ORadj 0.85, 95% CI 0.79 to 0.92, p <0.001), whereas there was no difference in myocardial infarction (ORadj 0.97, 95% CI 0.89 to 1.07) or revascularization (ORadj 1.05, 95% CI 0.92 to 1.20). Hospital readmissions were increased at 180 days in patients who underwent PCI in public reporting states (ORadj 1.08, 95% CI 1.03 to 1.12, p = 0.001). In conclusion, patients who underwent PCI in states with mandated public reporting of outcomes had similar predicted risks but significantly lower observed risks of death during hospitalization and in the 6 months after PCI. These findings support considering public reporting as a potential strategy for improving outcomes of patients who underwent PCI although further studies are warranted to delineate the reasons for these differences.
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U2 - 10.1016/j.amjcard.2015.02.050
DO - 10.1016/j.amjcard.2015.02.050
M3 - Article
C2 - 25891991
AN - SCOPUS:84929265133
SN - 0002-9149
VL - 115
SP - 1494
EP - 1501
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 11
ER -