title: State mandated public reporting and outcomes of percutaneous coronary intervention in the United States.
abstract: Public reporting has been proposed as a strategy to improve health care quality. Percutaneous coronary interventions (PCIs) performed in the United States from July 1, 2009, to June 30, 2011, included in the CathPCI Registry were identified (n = 1,340,213). Patient characteristics and predicted and observed in-hospital mortality were compared between patients treated with PCI in states with mandated public reporting (Massachusetts, New York, Pennsylvania) and states without mandated public reporting. Most PCIs occurred in states without mandatory public reporting (88%, n = 1,184,544). Relative to patients treated in nonpublic reporting states, those who underwent PCI in public reporting states had similar predicted in-hospital mortality (1.39% vs 1.37%, p = 0.17) but lower observed in-hospital mortality (1.19% vs 1.41%, adjusted odds ratio [ORadj] 0.80; 95% confidence interval [CI] 0.74, 0.88; p <0.001). In patients for whom outcomes were available at 180 days, the differences in mortality persisted (4.6% vs 5.4%, ORadj 0.85, 95% CI 0.79 to 0.92, p <0.001), whereas there was no difference in myocardial infarction (ORadj 0.97, 95% CI 0.89 to 1.07) or revascularization (ORadj 1.05, 95% CI 0.92 to 1.20). Hospital readmissions were increased at 180 days in patients who underwent PCI in public reporting states (ORadj 1.08, 95% CI 1.03 to 1.12, p = 0.001). In conclusion, patients who underwent PCI in states with mandated public reporting of outcomes had similar predicted risks but significantly lower observed risks of death during hospitalization and in the 6 months after PCI. These findings support considering public reporting as a potential strategy for improving outcomes of patients who underwent PCI although further studies are warranted to delineate the reasons for these differences.
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: mcavender@partners.org.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Cavender
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard School of Public Health, VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Joynt
authors.affiliation: Yale Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Parzynski
authors.affiliation: Lahey Clinic, Burlington, Massachusetts.
authors.forename: Frederick S
authors.initials: FS
authors.lastname: Resnic
authors.affiliation: Denver VA Medical Center, Denver, Colorado.
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.affiliation: University of Miami School of Medicine, Miami, Florida.
authors.forename: Mauro
authors.initials: M
authors.lastname: Moscucci
authors.affiliation: University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: Yale Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: University of Michigan, Ann Arbor, Michigan.
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D019221:Mandatory Reporting; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention; D014481:United States