NCDR Studies Examine PCI Process and Outcome Measures, Risk of Adverse Events After Discharge

Two studies using the NCDR's CathPCI Registry provide new insights into hospital performance for PCI process and outcomes measures, as well as the impact of acute kidney injury (AKI) after PCI on adverse clinical events.

A cross-sectional analysis published in the Journal of the American Heart Association found that median hospital performance for many PCI process measures exceeded 90 percent, demonstrating minimal opportunity for improvement. Philip W. Chui, MD, et al., analyzed 1,268,860 PCIs performed between Jan. 1, 2010 and Dec. 31, 2011 across 1,331 hospitals. By linking CathPCI Registry data with Medicare claims data, the authors assessed hospital performance using the established process measures, newly proposed Physician Consortium for Performance Improvement (PCPI) process measures and a composite of all measures.

The results show strong correlations between medication-specific process measures (p < 0.01), but weak correlations between the newly proposed PCPI process measures and established process measures. Despite this, only 1.3 percent to 2 percent of the observed variation in mortality and readmission rates could be explained by the composite process measures, which "suggest that process and outcome measures capture complementary, and not overlapping, domains of quality."

"Our findings raise questions as to whether there is enough of a gap in current performance to justify further investment in the proposed PCPI metrics," write the study authors. Instead, "it may be worth focusing quality measurement efforts on expanding the portfolio of outcomes measures, such as rates of bleeding, acute kidney injury, and patient-report health status following PCI."

In another study, the largest evaluation of a contemporary cohort of PCI patients using a standardized definition of AKI, found that AKI was significantly associated with increased risk of death, myocardial infarction, bleeding and recurrent kidney injury after discharge. Most of these events occurred within the first 30 days, but the risk continued out to one year. The study was published in Circulation: Cardiovascular Interventions.

Led by Javier A. Valle, MD, et al., the study linked patient data from the CathPCI Registry to Center for Medicare and Medicaid Services billing data between Nov. 29, 2004 and Dec. 31, 2009. Of the 453,475 patients who underwent a PCI, 8.8 percent developed in-hospital AKI post PCI.

"Hazard for mortality and adverse events after AKI have not significantly changed from studies performed before our current awareness of the risks associated with AKI, suggesting an ongoing opportunity to develop possible interventions after the development of AKI to mitigate risk of downstream events," write the study authors.

They suggest future research should "identify novel risk factors and better define possible interventions," recognizing that "defining this population and their high risk in the immediate post-discharge period is an important first step and offers a time period for clinicians to focus on."

Keywords: Risk Factors, Medicaid, Cross-Sectional Studies, Process Assessment (Health Care), American Heart Association, Investments, Patient Readmission, Acute Kidney Injury, Kidney, Medicare, Registries, Myocardial Infarction, Outcome Assessment (Health Care), Health Status

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