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Multicenter Study
. 2018 Jul 1;3(7):629-634.
doi: 10.1001/jamacardio.2018.1095.

A Survey of Interventional Cardiologists' Attitudes and Beliefs About Public Reporting of Percutaneous Coronary Intervention

Daniel M Blumenthal  1   2   3 , Linda R Valsdottir  3 , Yuansong Zhao  3 , Changyu Shen  3   4 , Ajay J Kirtane  5   6 , Duane S Pinto  2   3   4 , Fred S Resnic  7 , Karen E Joynt Maddox  8 , Jason H Wasfy  1   2 , Roxana Mehran  9 , Ken Rosenfield  1   2 , Robert W Yeh  2   3   4
Affiliations
Multicenter Study

A Survey of Interventional Cardiologists' Attitudes and Beliefs About Public Reporting of Percutaneous Coronary Intervention

Daniel M Blumenthal et al. JAMA Cardiol. .

Abstract

Importance: Public reporting of procedural outcomes has been associated with lower rates of percutaneous coronary intervention (PCI) and worse outcomes after myocardial infarction. Contemporary data are limited on the influence of public reporting on interventional cardiologists' clinical decision making.

Objective: To survey a contemporary cohort of interventional cardiologists in Massachusetts and New York about how public reporting of PCI outcomes influences clinical decision making.

Design, setting, and participants: An online survey was developed with public reporting experts and administered electronically to eligible physicians in Massachusetts and New York who were identified by Doximity (an online physician networking site) and 2014 Medicare fee-for-service claims for PCI procedures. The personal and hospital characteristics of participants were ascertained via a comprehensive database from Doximity and the American Hospital Association annual surveys of US hospitals (2012 and 2013) and linked to survey responses. Associations between survey responses and characteristics of participants were evaluated in univariable and multivariable analyses.

Main outcomes and measures: Reported rate of avoidance of performing PCIs in high-risk patients and of perception of pressure from colleagues to avoid performing PCIs.

Results: Of the 456 physicians approached, 149 (32.7%) responded, including 67 of 129 (51.9%) in Massachusetts and 82 of 327 (25.1%) in New York. The mean (SD) age was 49 (9.2) years; 141 of 149 participants (94.6%) were men. Most participants reported practicing at medium to large, nonprofit hospitals with high-volume cardiac catheterization laboratories and cardiothoracic surgery capabilities. In 2014, participants had higher annual PCI volumes among Medicare patients than nonparticipants did (median, 31; interquartile range [IQR], 13-47 vs median, 17; IQR, 0-41; P < .001). Among participants, 65% reported avoiding PCIs on at least 2 occasions becase of concern that a bad outcome would negatively impact their publicly reported outcomes; 59% reported sometimes or often being pressured by colleagues to avoid performing PCIs because of a concern about the patient's risk of death. After multivariable adjustment, more years of experience practicing interventional cardiology was associated with lower odds of PCI avoidance. The state of practice was not associated with survey responses.

Conclusions and relevance: Current PCI public reporting programs can foster risk-averse clinical practice patterns, which do not vary significantly between interventional cardiologists in New York and Massachusetts. Coordinated efforts by policy makers, health systems leadership, and the interventional cardiology community are needed to mitigate these unintended consequences.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Blumenthal reports receiving research support from the John S. LaDue Memorial Fellowship at Harvard Medical School and consulting fees and/or funding for unrelated work from Devoted Health, Novartis Pharmaceuticals, HLM Venture Partners, and Precision Health Economics. Dr Kirtane reports institutional grants to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CathWorks, Siemens, Philips, and ReCor Medical. Dr Joynt Maddox reports support from the National Heart, Lung, and Blood Institute of the National Institutes of Health (grant 5K23HL109177-03). Dr Wasfy reports a career development award from the National Institutes of Health and Harvard Catalyst (grant KL2 TR001100). Dr Yeh reports receiving research funding for investigator-initiated research from Abiomed for the conduct of this study. Dr Mehran reports institutional grants to Icahn School of Medicine at Mount Sinai from AstraZeneca, Bayer, Beth Israel Deaconess, Bristol-Myers Squibb, CSL Behring, Eli Lilly/Daiichi Sankyo, Medtronic, Novartis Pharmaceuticals, and OrbusNeich; consultant fees from Abbott Laboratories, CardioKinetix, Spectranetics, Boston Scientific, Cardiovascular Systems Inc, and Medscape; participation in advisory boards or executive committees of Bristol-Myers Squibb, Janssen Pharmaceuticals, and Osprey Medical; participation on the data and safety monitoring board of Watermark Research Partners; and equity stakes in Claret Medical and Elixir Medical. Dr Pinto reports personal fees from Medtronic, Boston Scientific, and Abiomed Inc. Dr Wasfy reports grants from the National Institutes of Health outside the submitted work. Dr Rosenfield reports research or fellowship support from Atrium-Getinge, Inari Medical, National Institutes of Health, and Lutonix-BARD; board membership on VIVA Physicians and National PERT Consortium; consultant or scientific advisory board positions with Abbott Vascular, Cardinal Health, Cook, Thrombolex, Surmodics, Volcano/Philips, and Amegen; consultant or scientific advisory board positions with stock or equity with Capture Vascular, Contego, Cruzar Systems, Endospan, Eximo, MD Insider, Micell, Shockwave, Silk Road Medical, Valcare, and Thrombolex; and personal equity in PQ Bypass, Primacea, Capture Vascular, VORTEX, MD Insider, Micell, Shockwave, Cruzar Systems, Endospan, Eximo, Valcare, and Contego. No other disclosures were reported.

Figures

Figure.
Figure.. Public Reporting of Percutaneous Coronary Intervention, Risk Aversion, and Gaming of Public Reporting Systems
Responses are included from 149 interventional cardiologists in Massachusetts and New York to 5 survey questions about public reporting of percutaneous coronary intervention (PCI) outcomes, systems-level support for performing PCIs in high-risk patients, individual clinicians’ avoidance of high-risk PCIs, and interventional cardiologists’ impressions of the prevalence of purposeful upcoding of comorbidities by colleagues.
See this image and copyright information in PMC

References

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