Is There a Link Between Public Reporting and PCI Outcomes?
Patients who underwent percutaneous coronary intervention (PCI) in states with mandated public reporting of outcomes had similar predicted risks but significantly lower observed risks of death during hospitalization and six months after PCI, according to a study based on data from the ACC's CathPCI Registry and published recently in The American Journal of Cardiology.
Researchers used the registry to evaluate the relationship between mandatory public reporting and patient selection for PCI by identifying differences in patient characteristics, cardiac status, and indications for PCI in states with and without mandatory public reporting. They also evaluated the relationship between reporting and quality of care, as measured by care processes – and compared predicted and actual in-hospital mortality and other outcomes in patients who underwent PCI in states with and without mandatory public reporting.
Data from 1,340,213 PCI procedures captured in the CathPCI Registry between July 1, 2009, to June 30, 2011, were assessed. Compared to patients treated in non-public reporting states, those who underwent PCI in public reporting states had similar predicted in-hospital mortality (1.39 percent vs 1.37 percent) but lower observed in-hospital mortality (1.19 percent vs 1.41 percent). In patients for whom outcomes were available at 180 days, the differences in mortality persisted (4.6 percent vs 5.4 percent), whereas there was no difference in myocardial infarction or revascularization. Hospital readmissions were increased at 180 days in patients who underwent PCI in public reporting states.
Public reporting "programs have been designed with the idea that increasing the amount of information available will result in better clinical outcomes. Previous studies have shown that public reporting can improve implementation of quality measures; however, before this study, there have been no clinical outcome studies that support the efficacy of a public reporting strategy," the authors write.
While the limitations of the study should be considered and further studies are warranted to delineate the reasons for the differences shown, the findings support the consideration of public reporting as a potential strategy for improving outcomes of patients undergoing PCI.
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