Advertisement






Click here for more guidelines.
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2005; 45:1759-1765, doi:10.1016/j.jacc.2005.01.055
© 2005 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Web of Science (24)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Moscucci, M.
Right arrow Articles by Brown, D. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Moscucci, M.
Right arrow Articles by Brown, D. L.
Related Collections
Right arrowRelated Article

CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Public Reporting and Case Selection for Percutaneous Coronary Interventions

An Analysis From Two Large Multicenter Percutaneous Coronary Intervention Databases

Mauro Moscucci, MD*,*, Kim A. Eagle, MD*, David Share, MD, MPH{dagger}, Dean Smith, PhD, MS*, Anthony C. De Franco, MD{ddagger}, Michael O’Donnell, MD§, Eva Kline-Rogers, RN, MS*, Sandeep M. Jani, MPH* and David L. Brown, MD||

* University of Michigan Health System, Ann Arbor, Michigan
{dagger} Blue Cross Blue Shield Center for Health Care Quality, Detroit, Michigan
{ddagger} McLaren Regional Medical Center, Flint, Michigan
§ St. Joseph Mercy Hospital, Ann Arbor, Michigan
|| State University of New York-Stony Brook School of Medicine, Stony Brook, New York

Manuscript received September 10, 2004; revised manuscript received January 13, 2005, accepted January 17, 2005.

* Reprint requests and correspondence: Dr. Mauro Moscucci, Taubman Center B1-226, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0311. (Email: moscucci{at}umich.edu).

OBJECTIVES: The purpose of this research was to determine the potential effect of public reporting on case selection for percutaneous coronary intervention (PCI).

BACKGROUND: Previous studies have suggested that public reporting of coronary artery bypass graft surgery (CABG) mortality might result in case selection bias and in denial of care to or out migration of high-risk patients. The potential effect of public reporting on case selection for PCI is unknown.

METHODS: We compared demographics, indications, and outcomes of 11,374 patients included in a multicenter (eight hospitals) PCI database in Michigan where no public reporting is present, with 69,048 patients in a statewide (34 hospitals) PCI database in New York, where public reporting is present. The primary end point was in-hospital mortality.

RESULTS: Patients in Michigan more frequently underwent PCI for acute myocardial infarction (14.4% vs. 8.7%, p < 0.0001) and cardiogenic shock (2.56% vs. 0.38%, p < 0.0001) than those in New York. The Michigan cohort also had a higher prevalence of congestive heart failure and extracardiac vascular disease. The unadjusted in-hospital mortality rate was significantly lower in New York than in Michigan (0.83% vs. 1.54%, p < 0.0001; odds ratio [OR] 0.54, 95% confidence interval [CI] 0.45 to 0.63). However, after adjustment for comorbidities, there was no significant difference in mortality between the two groups (adjusted OR 1.05, 95% CI 0.84 to 1.31, p = 0.70, c-statistic 0.88).

CONCLUSIONS: There are significant differences in case mix between patients undergoing PCI in Michigan and New York that result in marked differences in unadjusted mortality rates. A propensity in New York toward not intervening on higher-risk patients because of fear of public reporting of high mortality rates is a possible explanation for these differences.

Abbreviations and Acronyms
  CABG = coronary artery bypass graft surgery
  CI = confidence interval
  MI = myocardial infarction
  OR = odds ratio
  PCI = percutaneous coronary intervention


Related Article

The Big Chill: The Deleterious Effects of Public Reporting on Access to Health Care for the Sickest Patients
Zoltan G. Turi
J. Am. Coll. Cardiol. 2005 45: 1766-1768. [Full Text] [PDF]



This article has been cited by other articles:


Home page
J Am Coll Cardiol IntvHome page
L. W. Klein, P. Kolm, X. Xu, R. J. Krone, H. V. Anderson, J. S. Rumsfeld, R. G. Brindis, and W. S. Weintraub
A Longitudinal Assessment of Coronary Interventional Program Quality: A Report From the American College of Cardiology-National Cardiovascular Data Registry
J. Am. Coll. Cardiol. Intv., February 1, 2009; 2(2): 136 - 143.
[Abstract] [Full Text] [PDF]


Home page
Med Decis MakingHome page
M. Pine, H. S. Jordan, A. Elixhauser, D. E. Fry, D. C. Hoaglin, B. Jones, R. Meimban, D. Warner, and J. Gonzales
Modifying ICD-9-CM Coding of Secondary Diagnoses to Improve Risk-Adjustment of Inpatient Mortality Rates
Med Decis Making, January 1, 2009; 29(1): 69 - 81.
[Abstract] [PDF]


Home page
HeartHome page
P. F Ludman
Assessing the risks of percutaneous coronary intervention: do we have an equivalent of the EuroSCORE?
Heart, November 1, 2008; 94(11): 1366 - 1369.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
T. Y. Wang, E. D. Peterson, D. Dai, H. V. Anderson, S. V. Rao, R. G. Brindis, M. T. Roe, and on behalf of the National Cardiovascular Data Regi
Patterns of Cardiac Marker Surveillance After Elective Percutaneous Coronary Intervention and Implications for the Use of Periprocedural Myocardial Infarction as a Quality Metric: A Report From the National Cardiovascular Data Registry (NCDR)
J. Am. Coll. Cardiol., May 27, 2008; 51(21): 2068 - 2074.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
H. S. Gurm, D. E. Smith, J. S. Collins, D. Share, A. Riba, A. J. Carter, T. LaLonde, E. Kline-Rogers, M. O'Donnell, H. Changezi, et al.
The relative safety and efficacy of abciximab and eptifibatide in patients undergoing primary percutaneous coronary intervention insights from a large regional registry of contemporary percutaneous coronary intervention.
J. Am. Coll. Cardiol., February 5, 2008; 51(5): 529 - 535.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
H. R. Reynolds and J. S. Hochman
Cardiogenic Shock: Current Concepts and Improving Outcomes
Circulation, February 5, 2008; 117(5): 686 - 697.
[Full Text] [PDF]


Home page
ANN INTERN MEDHome page
C. H. Fung, Y.-W. Lim, S. Mattke, C. Damberg, and P. G. Shekelle
Systematic Review: The Evidence That Publishing Patient Care Performance Data Improves Quality of Care
Ann Intern Med, January 15, 2008; 148(2): 111 - 123.
[Abstract] [Full Text] [PDF]


Home page
HeartHome page
M. R Ward and B. Bridgewater
Implications of publishing surgical results
Heart, September 1, 2007; 93(9): 1136 - 1136.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
S. B. King III, T. Aversano, W. L. Ballard, R. H. Beekman III, M. J. Cowley, S. G. Ellis, D. P. Faxon, E. L. Hannan, J. W. Hirshfeld Jr, A. K. Jacobs, et al.
ACCF/AHA/SCAI 2007 Update of the Clinical Competence Statement on Cardiac Interventional Procedures: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (Writing Committee to Update the 1998 Clinical Competence Statement on Recommendations for the Assessment and Maintenance of Proficiency in Coronary Interventional Procedures)
J. Am. Coll. Cardiol., July 3, 2007; 50(1): 82 - 108.
[Full Text] [PDF]


Home page
Arch Intern MedHome page
A. T. Yan, R. T. Yan, M. Tan, A. Fung, E. A. Cohen, D. H. Fitchett, A. Langer, S. G. Goodman, and for the Canadian Acute Coronary Syndromes 1 and 2
Management Patterns in Relation to Risk Stratification Among Patients With Non-ST Elevation Acute Coronary Syndromes
Arch Intern Med, May 28, 2007; 167(10): 1009 - 1016.
[Abstract] [Full Text] [PDF]


Home page
JAMAHome page
M. Pine, H. S. Jordan, A. Elixhauser, D. E. Fry, D. C. Hoaglin, B. Jones, R. Meimban, D. Warner, and J. Gonzales
Enhancement of Claims Data to Improve Risk Adjustment of Hospital Mortality
JAMA, January 3, 2007; 297(1): 71 - 76.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
H. M. Krumholz and F. A. Masoudi
The Year in Epidemiology, Health Services Research, and Outcomes Research
J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1886 - 1895.
[Full Text] [PDF]


Home page
Med Care Res RevHome page
A. J. Epstein
Do Cardiac Surgery Report Cards Reduce Mortality? Assessing the Evidence
Med Care Res Rev, August 1, 2006; 63(4): 403 - 426.
[Abstract] [PDF]


Home page
Journal of Health Politics, Policy and LawHome page
D. G. Stevenson
Is a public reporting approach appropriate for nursing home care?
Journal of Health Politics Policy and Law, August 1, 2006; 31(4): 773 - 810.
[Abstract] [PDF]


Home page
J Am Coll CardiolHome page
C. R. Smith
The Big Chill: Adverse Effects of Public Reporting on Access to Health Care
J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1737 - 1737.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
S. R. Dixon, C. L. Grines, and W. W. O'Neill
The Year in Interventional Cardiology
J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1689 - 1706.
[Full Text] [PDF]


Home page
HeartHome page
M Moscucci and D Share
Impact of health care initiatives on outcomes of acute coronary syndromes.
Heart, March 1, 2006; 92(3): 293 - 295.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, D. Sahn, and S. Tsimikas
Highlights of the Year in JACC 2005
J. Am. Coll. Cardiol., January 3, 2006; 47(1): 184 - 202.
[Full Text] [PDF]


Home page
NEJMHome page
J. D. Flaherty, C. J. Davidson, J. R. Crouse III, S. A. Rubin, F. V. Mody, E. L. Hannan, G. Walford, and R. H. Jones
Coronary-Artery Bypass Grafting versus Stent Implantation
N. Engl. J. Med., August 18, 2005; 353(7): 735 - 737.
[Full Text] [PDF]


Home page
JAMAHome page
A. Babaev, P. D. Frederick, D. J. Pasta, N. Every, T. Sichrovsky, J. S. Hochman, and for the NRMI Investigators
Trends in Management and Outcomes of Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock
JAMA, July 27, 2005; 294(4): 448 - 454.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
Z. G. Turi
The Big Chill: The Deleterious Effects of Public Reporting on Access to Health Care for the Sickest Patients
J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1766 - 1768.
[Full Text] [PDF]



 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement