Assessment of individual operator performance using a risk-adjustment model for percutaneous coronary interventions
Mario Gössl1, Charanjit S Rihal, Ryan J Lennon
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Insights
The Mayo Clinic Risk Score (MCRS) effectively assesses interventional cardiologist performance. Risk-adjusted outcomes using MCRS can enhance institutional quality metrics for percutaneous coronary intervention procedures.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Assessing individual interventional cardiologist performance is crucial for quality improvement.
- The Mayo Clinic Risk Score (MCRS) is a tool developed for risk adjustment in cardiac procedures.
Purpose of the Study:
- To evaluate the MCRS's applicability in assessing individual interventional cardiologist performance.
- To determine if risk-adjusted outcomes can serve as institutional quality metrics.
Main Methods:
- Analyzed 8187 percutaneous coronary intervention procedures performed by 21 interventional cardiologists across 3 Mayo Clinic sites (2007-2010).
- Estimated observed and expected mortality and major adverse cardiac events (MACE) using MCRS.
- Recalibrated risk estimates by excluding individual performers to compare operator performance.
Main Results:
- Observed in-hospital mortality (1.8%) did not differ significantly from expected (1.6%; P=.24).
- Postprocedural MACE rates were significantly lower than predicted (observed 2.7% vs. expected 3.8%; P<.001).
- All but one cardiologist performed within expected variations; that operator showed excellent outcomes (MACE 1.0% vs. expected 4.4%).
Conclusions:
- The MCRS is a viable tool for assessing interventional cardiologist performance metrics.
- Risk-adjusted outcomes derived from MCRS can function as effective institutional quality metrics.
Objective:
To investigate the applicability of the Mayo Clinic Risk Score (MCRS) in the assessment of performance metrics of individual interventional cardiologists at 3 Mayo Clinic sites.
Participants And Methods:
We evaluated the risk-adjusted performance of 21 interventional cardiologists who performed 8187 percutaneous coronary intervention procedures at 3 Mayo Clinic sites from January 1, 2007, through December 31, 2010. Observed mortality, major adverse cardiac events (MACEs) (eg, death, Q-wave myocardial infarction, urgent or emergent coronary artery bypass graft, and stroke), and expected risk were estimated using the MCRS. To compare individual performance against the other operators, risk estimates were recalibrated by excluding the individual performer from logistic regression models.
Results:
The log odds ratio for observed vs estimated risk was estimated for each interventional cardiologist, and their individual effects were then plotted on a normal probability plot to identify outliers. Observed in-hospital mortality was not different than expected (1.8% vs 1.6%; P=.24); however, the postprocedural MACE rate was lower than predicted (observed, 2.7%; expected, 3.8%; P<.001). All but one interventional cardiologist had MACE and death rates within the expected variation. Detailed assessment of that operator's risk performance produced excellent outcomes (observed vs expected MACE rate, 1.0% vs 4.4%).
Conclusion:
The MCRS can serve as a tool for the assessment of performance metrics for interventional cardiologists, and risk-adjusted outcomes may serve as a better surrogate for institutional quality metrics.
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