title: Association between public reporting of outcomes with procedural management and mortality for patients with acute myocardial infarction.
abstract: BACKGROUND
  Public reporting of procedural outcomes may create disincentives to provide percutaneous coronary intervention (PCI) for critically ill patients.
  
  
  OBJECTIVE
  This study evaluated the association between public reporting with procedural management and outcomes among patients with acute myocardial infarction (AMI).
  
  
  METHODS
  Using the Nationwide Inpatient Sample, we identified all patients with a primary diagnosis of AMI in states with public reporting (Massachusetts and New York) and regionally comparable states without public reporting (Connecticut, Maine, Maryland, New Hampshire, Rhode Island, and Vermont) between 2005 and 2011. Procedural management and in-hospital outcomes were stratified by public reporting.
  
  
  RESULTS
  Among 84,121 patients hospitalized with AMI, 57,629 (69%) underwent treatment in a public reporting state. After multivariate adjustment, percutaneous revascularization was performed less often in public reporting states than in nonreporting states (odds ratio [OR]: 0.81, 95% confidence interval [CI]: 0.67 to 0.96), especially among older patients (OR: 0.75, 95% CI: 0.62 to 0.91), those with Medicare insurance (OR: 0.75, 95% CI: 0.62 to 0.91), and those presenting with ST-segment elevation myocardial infarction (OR: 0.63, 95% CI: 0.56 to 0.71) or concomitant cardiac arrest or cardiogenic shock (OR: 0.58, 95% CI: 0.47 to 0.70). Overall, patients with AMI in public reporting states had higher adjusted in-hospital mortality rates (OR: 1.21, 95% CI: 1.06 to 1.37) than those in nonreporting states. This was observed predominantly in patients who did not receive percutaneous revascularization in public reporting states (adjusted OR: 1.30, 95% CI: 1.13 to 1.50), whereas those undergoing the procedure had lower mortality (OR: 0.71, 95% CI: 0.62 to 0.83).
  
  
  CONCLUSIONS
  Public reporting is associated with reduced percutaneous revascularization and increased in-hospital mortality among patients with AMI, particularly among patients not selected for PCI.
authors: Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.
authors: Stephen W
authors: SW
authors: Waldo
authors: Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington.
authors: James M
authors: JM
authors: McCabe
authors: Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.
authors: Cashel
authors: C
authors: O'Brien
authors: Saint Luke's Mid-America Heart Institute, Kansas City, Missouri.
authors: Kevin F
authors: KF
authors: Kennedy
authors: Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Karen E
authors: KE
authors: Joynt
authors: Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: ryeh@partners.org.
authors: Robert W
authors: RW
authors: Yeh
mesh_terms: D022126:Access to Information; D000368:Aged; D000369:Aged, 80 and over; D030881:Disclosure; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D009204:Myocardial Revascularization / Q000401:mortality / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States
keywords: acute coronary syndromes(s); percutaneous coronary intervention; public reporting