title: Risk scores do not adjust for aggressive, evidence-based changes in percutaneous coronary intervention practice patterns.
abstract: OBJECTIVE
  Public reporting of procedural outcomes leads to risk averse behavior because physicians do not believe the scores account for patient risk. We investigated the effects of more aggressive percutaneous coronary intervention (PCI) practice on risk-adjusted mortality.
  
  
  RESULTS
  8935 PCI were performed. Risk adjustment was performed with the New York State PCI risk score. The cohort was divided into two eras based on programs implemented to promote more aggressive care. Between eras, overall adjusted mortality ratios rose from 0.66 to 0.90 (observed/predicted, p = 0.02), despite evidence supporting consistent procedural quality.
  
  
  CONCLUSIONS
  Evidence-based changes in PCI practice were associated with worsening risk-adjusted procedural mortality. These data are consistent with physician beliefs regarding risk-adjusted outcome measures.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, M5S 2J7, Canada.
authors.forename: Steven Es
authors.initials: SE
authors.lastname: Miner
authors.forename: Lynne E
authors.initials: LE
authors.lastname: Nield
authors.forename: Sylvain
authors.initials: S
authors.lastname: Plante
authors.forename: Lorne
authors.initials: L
authors.lastname: Goldman
authors.forename: Manu
authors.initials: M
authors.lastname: Prabhakar
authors.forename: Karen
authors.initials: K
authors.lastname: Elliott
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment
keywords: behavioral sciences; health policy; mortality; percutaneous coronary intervention; risk scores