title: Assessment of individual operator performance using a risk-adjustment model for percutaneous coronary interventions.
abstract: 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.
  
  
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Mario
authors.initials: M
authors.lastname: Gössl
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
mesh_terms: D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D020379:Risk Adjustment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome
keywords: CABG; MACE; MCRS; MI; Mayo Clinic Risk Score; OR; PCI; coronary artery bypass graft; major adverse cardiovascular event; myocardial infarction; odds ratio; percutaneous coronary intervention