title: Association of public reporting for percutaneous coronary intervention with utilization and outcomes among Medicare beneficiaries with acute myocardial infarction.
abstract: BACKGROUND
  Public reporting of patient outcomes is an important tool to improve quality of care, but some observers worry that such efforts will lead clinicians to avoid high-risk patients.
  
  
  OBJECTIVE
  To determine whether public reporting for percutaneous coronary intervention (PCI) is associated with lower rates of PCI for patients with acute myocardial infarction (MI) or with higher mortality rates in this population.
  
  
  METHODS
  Retrospective observational study conducted using data from fee-for-service Medicare patients (49,660 from reporting states and 48,142 from nonreporting states) admitted with acute MI to US acute care hospitals between 2002 and 2010. Logistic regression was used to compare PCI and mortality rates between reporting states (New York, Massachusetts, and Pennsylvania) and regional nonreporting states (Maine, Vermont, New Hampshire, Connecticut, Rhode Island, Maryland, and Delaware). Changes in PCI rates over time in Massachusetts compared with nonreporting states were also examined.
  
  
  METHODS
  Risk-adjusted PCI and mortality rates.
  
  
  RESULTS
  In 2010, patients with acute MI were less likely to receive PCI in public reporting states than in nonreporting states (unadjusted rates, 37.7% vs 42.7%, respectively; risk-adjusted odds ratio [OR], 0.82 [95% CI, 0.71-0.93]; P = .003). Differences were greatest among the 6708 patients with ST-segment elevation MI (61.8% vs 68.0%; OR, 0.73 [95% CI, 0.59-0.89]; P = .002) and the 2194 patients with cardiogenic shock or cardiac arrest (41.5% vs 46.7%; OR, 0.79 [95% CI, 0.64-0.98]; P = .03). There were no differences in overall mortality among patients with acute MI in reporting vs nonreporting states. In Massachusetts, odds of PCI for acute MI were comparable with odds in nonreporting states prior to public reporting (40.6% vs 41.8%; OR, 1.00 [95% CI, 0.71-1.41]). However, after implementation of public reporting, odds of undergoing PCI in Massachusetts decreased compared with nonreporting states (41.1% vs 45.6%; OR, 0.81 [95% CI, 0.47-1.38]; P = .03 for difference in differences). Differences were most pronounced for the 6081 patients with cardiogenic shock or cardiac arrest (prereporting: 44.2% vs 36.6%; OR, 1.40 [95% CI, 0.85-2.32]; postreporting: 43.9% vs 44.8%; OR, 0.92 [95% CI, 0.38-2.22]; P = .03 for difference in differences).
  
  
  CONCLUSIONS
  Among Medicare beneficiaries with acute MI, the use of PCI was lower for patients treated in 3 states with public reporting of PCI outcomes compared with patients treated in 7 regional control states without public reporting. However, there was no difference in overall acute MI mortality between states with and without public reporting.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA. kjoynt@partners.org
authors.forename: Karen E
authors.initials: KE
authors.lastname: Joynt
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Blumenthal
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
authors.forename: Frederic S
authors.initials: FS
authors.lastname: Resnic
authors.forename: Ashish K
authors.initials: AK
authors.lastname: Jha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000592:standards / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D019221:Mandatory Reporting; D006278:Medicare / Q000706:statistics & numerical data*; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D011785:Quality Assurance, Health Care; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology