State mandated public reporting and outcomes of percutaneous coronary intervention in the United States

Abstract

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.

Figure 1.

Study flow diagram.

Figure 2.

Unadjusted and adjusted ORs comparing the odds of in-hospital death in public reporting versus nonreporting states for all patients and various subgroups. All tests compare public reporting states to nonpublic reporting states within each rows’ designated group (e.g., all patients in public reporting states vs all patients in nonpublic reporting States). “†,” Estimates for these groups were derived using stratified analyses. Model 1—adjusted for factors included in the NCDR risk score model. Model 2—adjusted for factors included in the NCDR risk score model, female gender, current/recent smoker (within 1 year), dyslipidemia, family history of premature CAD, antianginal medication within 2 weeks before PCI, previous cardiac arrest, anginal classification within 2 weeks, Canadian Cardiovascular Society class I angina versus no symptoms, Canadian Cardiovascular Society class II angina versus no symptoms, Canadian Cardiovascular Society class III angina versus no symptoms, Canadian Cardiovascular Society class IV angina versus no symptoms, hemoglobin, preprocedure hemoglobin (g/dl), hemoglobin (unknown), and hospital type (non-for-profit vs public, private vs public).

Figure 3.

Cumulative incidence of (A) death, (B) myocardial infarction, (C) revascularization, (D) readmission in public reporting, and nonpublic reporting states with patients with available Medicare data. OR adjusted for factors included in the NCDR risk score model, female gender, current/recent smoker (within 1 year), dyslipidemia, family history of premature CAD, antianginal medication within 2 weeks before PCI, previous cardiac arrest, anginal classification within 2 weeks, Canadian Cardiovascular Society class I angina versus no symptoms, Canadian Cardiovascular Society class II angina versus no symptoms, Canadian Cardiovascular Society class III angina versus no symptoms, Canadian Cardiovascular Society class IV angina versus no symptoms, hemoglobin, preprocedure hemoglobin (g/dl), hemoglobin (unknown), and hospital type (non-for-profit vs public, private vs public).