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J Am Heart Assoc. 2017 Apr 26;6(5). pii: e004276. doi: 10.1161/JAHA.116.004276.

Hospital Performance on Percutaneous Coronary Intervention Process and Outcomes Measures.

Author information

1
Department of Internal Medicine, University of California Irvine School of Medicine, Orange, CA.
2
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.
3
Center for Clinical Management Research, Ann Arbor VA Medical Center, University of Michigan Medical School, Ann Arbor, MI.
4
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
5
Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
6
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.
7
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
8
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT jeptha.curtis@yale.edu.

Abstract

BACKGROUND:

The Physician Consortium for Performance Improvement recently proposed percutaneous coronary intervention (PCI)-specific process measures. However, information about hospital performance on these measures and the association of PCI process and outcomes measures are not available.

METHODS AND RESULTS:

We linked the National Cardiovascular Data Registry (NCDR) CathPCI Registry with Medicare claims data to assess hospital performance on established PCI process measures (aspirin, thienopyridines, and statins on discharge; door-to-balloon time; and referral to cardiac rehabilitation), newly proposed PCI process measures (documentation of contrast dose, glomerular filtration rate, and PCI indication; appropriate indication for elective PCI; and use of embolic protection device), and a composite of all process measures. We calculated weighted pair-wise correlations between each set of process metrics and performed weighted correlation analyses to assess the association between composite measure performance with corresponding 30-day risk-standardized mortality and readmission rates. We reported the variance in risk-standardized 30-day outcome rates explained by process measures. We analyzed 1 268 860 PCIs from 1331 hospitals. For many process measures, median hospital performance exceeded 90%. We found strong correlations between medication-specific process measures (P<0.01) and weak correlations between hospital performance on the newly proposed and established process measures. The composite process measure explained only 1.3% and 2.0% of the observed variation in mortality and readmission rates, respectively.

CONCLUSIONS:

Hospital performance on many PCI-specific process measures demonstrated little opportunity for improvement and explained only a small percentage of hospital variation in 30-day outcomes. Efforts to measure and improve hospital quality for PCI patients should focus on both process and outcome measures.

KEYWORDS:

outcomes; percutaneous coronary interventions; process measures; readmissions

PMID:
28446493
PMCID:
PMC5524055
DOI:
10.1161/JAHA.116.004276
[Indexed for MEDLINE]
Free PMC Article

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