Hospital Performance on Percutaneous Coronary Intervention Process and Outcomes Measures

Area of Science:

• Cardiovascular Medicine
• Health Services Research
• Quality Improvement

Background:

• Physician groups proposed new percutaneous coronary intervention (PCI)-specific process measures.
• Data on hospital performance and the link between PCI process and outcomes were limited.

Purpose of the Study:

• To assess hospital performance on established and proposed PCI process measures.
• To examine the association between PCI process measures and 30-day outcomes.

Main Methods:

• Linked National Cardiovascular Data Registry (NCDR) CathPCI Registry with Medicare claims.
• Assessed hospital performance on various process measures, including medications, door-to-balloon time, and documentation.
• Analyzed correlations between process measures and 30-day risk-standardized mortality and readmission rates.

Main Results:

• Median hospital performance exceeded 90% for many process measures.
• Strong correlations existed between medication-specific process measures; weaker correlations between proposed and established measures.
• The composite process measure explained only 1.3% of mortality variation and 2.0% of readmission variation.

Conclusions:

• Many PCI process measures show little opportunity for improvement.
• Process measures explained a small fraction of hospital variation in 30-day outcomes.
• Future quality improvement should integrate both process and outcome measures for PCI care.