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Am Heart J. 2015 Dec;170(6):1227-33. doi: 10.1016/j.ahj.2015.09.006. Epub 2015 Sep 16.

Collaborative quality improvement vs public reporting for percutaneous coronary intervention: A comparison of percutaneous coronary intervention in New York vs Michigan.

Author information

  • 1Division of Cardiovascular Services, Spectrum Health Medical Group, Grand Rapids, MI. Electronic address: thomas.boyden@spectrumhealth.org.
  • 2Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
  • 3Division of Cardiology, Department of Medicine, Duke University, Durham, NC.
  • 4Division of Cardiology, Department of Medicine, Beaumont Hospital, Royal Oak, MI.
  • 5Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
  • 6Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI.

Abstract

INTRODUCTION:

Public reporting (PR) is a policy mechanism that may improve clinical outcomes for percutaneous coronary intervention (PCI). However, prior studies have shown that PR may have an adverse impact on patient selection. It is unclear whether alternatives to PR, such as collaborative quality improvement (CQI), may drive improvements in quality of care and outcomes for patients receiving PCI without the unintended consequences seen with PR.

METHODS:

Using National Cardiovascular Data Registry CathPCI Registry data from January 2011 through September 2012, we evaluated patients who underwent PCI in New York (NY), a state with PR (N = 51,983), to Michigan, a state with CQI (N = 53,528). We compared patient characteristics, the quality of care delivered, and clinical outcomes.

RESULTS:

Patients undergoing PCI in NY had a lower-risk profile, with a lower proportion of patients with ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, or cardiogenic shock, compared with Michigan. Quality of care was broadly similar in the 2 states; however, outcomes were better in NY. In a propensity-matched analysis, patients in NY were less likely to be referred for emergent, urgent, or salvage coronary artery bypass surgery (odds ratio [OR] 0.67, 95% CI 0.51-0.88, P < .0001) and to receive blood transfusion (OR 0.7, 95% CI 0.61-0.82, P < .0001), and had lower in-hospital mortality (OR 0.72, 95% CI 0.63-0.83, P < .0001).

CONCLUSIONS:

Public reporting of PCI data is associated with fewer high-risk patients undergoing PCI compared with CQI. However, in comparable samples of patients, PR is also associated with a lower risk of mortality and adverse events. The optimal quality improvement method may involve combining these 2 strategies to protect access to care while still driving improvements in patient outcomes.

Copyright © 2015 Elsevier Inc. All rights reserved.

PMID:
26678645
[PubMed - indexed for MEDLINE]
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