This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Resnic, F. S. Articles by Welt, F. G.P. Search for Related Content PubMed PubMed Citation Articles by Resnic, F. S. Articles by Welt, F. G.P. Related Collections Related Article

REVIEW AND COMMENTARY

The Public Health Hazards of Risk Avoidance Associated With Public Reporting of Risk-Adjusted Outcomes in Coronary Intervention

Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

Manuscript received March 27, 2008; revised manuscript received October 1, 2008, accepted November 24, 2008.

^_* Reprint requests and correspondence: Dr. Frederic S. Resnic, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115 (Email: fresnic{at}partners.org).

Public reporting of risk-adjusted outcomes for percutaneous coronary intervention (PCI) procedures has been mandated in New York State for more than a decade. During that time there has been a significant decline in the unadjusted mortality after such procedures. Massachusetts joined New York in 2003 as only the second state to require case level reporting of every coronary interventional procedure performed. In this review, we explore the differences in the populations reported by the 2 states and consider possible risks of public reporting of clinical outcomes after PCI procedures, including the risk of increasing conservatism in the treatment of the sickest patients. We offer a conceptual framework to understand the potential risk-averse behavior of interventional cardiologists subject to public reporting, and offer several proposals to counteract this potential deleterious effect of reporting programs.

Key Words: percutaneous coronary intervention • quality assurance • cardiogenic shock

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   PCI = percutaneous coronary intervention   STEMI = ST-elevation myocardial infarction

Related Article

Inside This Issue
J. Am. Coll. Cardiol. 2009 53: A35. [Full Text] [PDF]

This article has been cited by other articles:

				S. Kinlay The Trials and Tribulations of Percutaneous Coronary Intervention in Hospitals Without On-site CABG Surgery JAMA, December 14, 2011; 306(22): 2507 - 2509. [Full Text] [PDF]

				C. Feudtner, J. G. Berry, G. Parry, P. Hain, R. B. Morse, A. D. Slonim, S. S. Shah, and M. Hall Statistical Uncertainty of Mortality Rates and Rankings for Children's Hospitals Pediatrics, October 1, 2011; 128(4): e966 - e972. [Abstract] [Full Text] [PDF]

				D. M. Shahian, F. H. Edwards, J. P. Jacobs, R. L. Prager, S.-L. T. Normand, C. M. Shewan, S. M. O'Brien, E. D. Peterson, and F. L. Grover Public reporting of cardiac surgery performance: part 1-history, rationale, consequences. Ann. Thorac. Surg., September 1, 2011; 92(3 Suppl): S2 - S11. [Abstract] [Full Text] [PDF]

				K. Donelan, R. S. Rogers, A. Eisenhauer, E. Mort, and A. K. Agnihotri Consumer Comprehension of Surgeon Performance Data for Coronary Bypass Procedures Ann. Thorac. Surg., May 1, 2011; 91(5): 1400 - 1406. [Abstract] [Full Text] [PDF]

				S. G. Ellis, M. H. Shishehbor, S. R. Kapadia, A. M. Lincoff, R. Nair, P. L. Whitlow, C. T. Bajzer, L. L. Cho, E. M. Tuzcu, R. Raymond, et al. Enhanced Prediction of Mortality After Percutaneous Coronary Intervention by Consideration of General and Neurological Indicators J. Am. Coll. Cardiol. Intv., April 1, 2011; 4(4): 442 - 448. [Abstract] [Full Text] [PDF]

				F. S. Resnic, S.-L. T. Normand, T. C. Piemonte, S. J. Shubrooks, K. Zelevinsky, A. Lovett, and K. K. L. Ho Improvement in Mortality Risk Prediction After Percutaneous Coronary Intervention Through the Addition of a "Compassionate Use" Variable to the National Cardiovascular Data Registry CathPCI Dataset: A Study From the Massachusetts Angioplasty Registry J. Am. Coll. Cardiol., February 22, 2011; 57(8): 904 - 911. [Abstract] [Full Text] [PDF]

				E. D. Peterson The Need for "Compassionate Provider Profiling": Refining Risk Assessment for Percutaneous Coronary Intervention J. Am. Coll. Cardiol., February 22, 2011; 57(8): 912 - 913. [Full Text] [PDF]

				K. G. Barringhaus, K. Zelevinsky, A. Lovett, S.-L. T. Normand, and K. K. L. Ho Impact of Independent Data Adjudication on Hospital-Specific Estimates of Risk-Adjusted Mortality Following Percutaneous Coronary Interventions in Massachusetts Circ Cardiovasc Qual Outcomes, January 1, 2011; 4(1): 92 - 98. [Abstract] [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The Year in Interventional Cardiology J. Am. Coll. Cardiol., May 18, 2010; 55(20): 2272 - 2286. [Full Text] [PDF]

				P. F. Ludman and H. Routledge Chapter 3 Risk assessment and analysis of outcomes Oxford Textbook of Interventional Cardiology, January 1, 2010; 1(1): med-9780199569083-chapter - med-9780199569083-chapter. [Abstract] [Full Text]

				R. M. Califf and E. D. Peterson Public Reporting of Quality Measures: What Are We Trying to Accomplish? J. Am. Coll. Cardiol., March 10, 2009; 53(10): 831 - 833. [Full Text] [PDF]