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Public reporting and case selection for percutaneous coronary interventions: an analysis from two large multicenter
Mauro Moscucci1, Kim A Eagle, David Share
1University of Michigan Health System, Ann Arbor, Michigan, USA. moscucci@umich.edu
Journal of the American College of Cardiology
|June 7, 2005
Summary
Public reporting of percutaneous coronary intervention (PCI) outcomes may lead to case selection bias. New York, with public reporting, had lower unadjusted PCI mortality but similar adjusted mortality compared to Michigan, suggesting higher-risk patients were not treated.
Area of Science:
- Cardiovascular Interventions
- Health Services Research
- Public Health Policy
Background:
- Public reporting of surgical outcomes, like coronary artery bypass graft (CABG) surgery, may cause case selection bias.
- High-risk patients might be denied care or seek treatment elsewhere due to public reporting.
- The impact of public reporting on percutaneous coronary intervention (PCI) case selection remains unexamined.
Purpose of the Study:
- To investigate the potential influence of public reporting on patient selection for percutaneous coronary intervention (PCI).
- To compare case mix and outcomes of PCI patients in states with and without public reporting.
Main Methods:
- A comparative analysis of two large PCI databases: Michigan (no public reporting) and New York (public reporting).
- Demographic data, procedural indications, and in-hospital mortality were compared between 11,374 Michigan patients and 69,048 New York patients.
- In-hospital mortality was the primary endpoint, with adjustments for patient comorbidities.
Main Results:
- Michigan patients more frequently had PCI for acute myocardial infarction and cardiogenic shock, with higher rates of heart failure and other vascular diseases.
- Unadjusted in-hospital mortality was significantly lower in New York (0.83%) compared to Michigan (1.54%).
- After adjusting for comorbidities, no significant difference in mortality was observed between New York and Michigan (adjusted OR 1.05).
Conclusions:
- Significant differences in patient case mix exist between Michigan and New York PCI cohorts, explaining unadjusted mortality variations.
- Fear of public reporting may lead to a reluctance to perform PCI on higher-risk patients in New York.
- Public reporting may influence case selection, impacting the apparent mortality rates without altering actual patient outcomes after risk adjustment.