Risk scores do not adjust for aggressive, evidence-based changes in percutaneous coronary intervention practice
Steven Es Miner1, Lynne E Nield, Sylvain Plante
1Department of Medicine, University of Toronto, Toronto, ON, M5S 2J7, Canada.
Future Cardiology
|March 12, 2015
Summary
Public reporting of procedural outcomes may encourage risk-averse behavior. This study found that more aggressive percutaneous coronary intervention (PCI) practice was associated with increased risk-adjusted mortality, supporting physician concerns.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Public reporting of procedural outcomes is intended to improve quality of care.
- Physicians express concerns that risk adjustment models do not adequately account for patient complexity, potentially leading to risk-averse behavior.
Purpose of the Study:
- To investigate the impact of more aggressive percutaneous coronary intervention (PCI) practice on risk-adjusted mortality.
- To assess whether changes in PCI practice influence patient outcomes in a risk-adjusted manner.
Main Methods:
- Analysis of 8935 PCI procedures.
- Utilized the New York State PCI risk score for risk adjustment.
- Divided the patient cohort into two eras based on the implementation of programs promoting more aggressive care.
Main Results:
- The overall risk-adjusted mortality ratio increased from 0.66 to 0.90 between the two study eras (p = 0.02).
- This increase occurred despite evidence suggesting consistent procedural quality throughout the study period.
Conclusions:
- Evidence-based changes aimed at promoting more aggressive PCI practice were associated with a worsening of risk-adjusted procedural mortality.
- These findings align with physician concerns regarding the accuracy and fairness of risk-adjusted outcome measures.
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