title: Changes in Percutaneous Coronary Interventions Deemed "Inappropriate" by Appropriate Use Criteria.
abstract: BACKGROUND
  Recent studies have demonstrated relatively high rates of percutaneous coronary interventions (PCIs) classified as "inappropriate." The New York State Department of Health shared rates with hospitals and announced the intention of withholding reimbursement pending demonstration of clinical rationale for Medicaid patients with inappropriate PCIs.
  
  
  OBJECTIVE
  The objective was to examine changes over time in the number and rate of inappropriate PCIs.
  
  
  METHODS
  Appropriate use criteria were applied to PCIs performed in New York in patients without acute coronary syndromes or previous coronary artery bypass graft surgery in periods before (2010 through 2011) and after (2012 through 2014) efforts were made to decrease inappropriateness rates. Changes in the number of appropriate PCIs were also assessed.
  
  
  RESULTS
  The percentage of inappropriate PCIs for all patients dropped from 18.2% in 2010 to 10.6% in 2014 (from 15.3% to 6.8% for Medicaid patients, and from 18.6% to 11.2% for other patients). The total number of PCIs in patients with no acute coronary syndrome/no prior coronary artery bypass graft surgery that were rated as inappropriate decreased from 2,956 patients in 2010 to 911 patients in 2014, a reduction of 69%. For Medicaid patients, the decrease was from 340 patients to 84 patients, a decrease of 75%. For a select set of higher-risk scenarios, there were higher numbers of appropriate PCIs per year in the period from 2012 to 2014.
  
  
  CONCLUSIONS
  The inappropriateness rate for PCIs and the use of PCI for elective procedures in New York has decreased substantially between 2010 and 2014. This decrease has occurred for a large proportion of PCI hospitals.
authors.affiliation: Department of Health Policy, Management and Behavior, University at Albany, State University of New York, Albany, New York. Electronic address: edward.hannan@health.ny.gov.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Hannan
authors.affiliation: Department of Health Policy, Management and Behavior, University at Albany, State University of New York, Albany, New York.
authors.forename: Zaza
authors.initials: Z
authors.lastname: Samadashvili
authors.affiliation: Department of Health Policy, Management and Behavior, University at Albany, State University of New York, Albany, New York.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Cozzens
authors.affiliation: Office of Quality and Patient Safety, New York State Department of Health, Albany, New York.
authors.forename: Foster
authors.initials: F
authors.lastname: Gesten
authors.affiliation: Office of Health Insurance Programs, New York State Department of Health, Albany, New York.
authors.forename: Alda
authors.initials: A
authors.lastname: Osinaga
authors.affiliation: Office of Health Insurance Programs, New York State Department of Health, Albany, New York.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Fish
authors.affiliation: Office of Health Insurance Programs, New York State Department of Health, Albany, New York.
authors.forename: Constance L
authors.initials: CL
authors.lastname: Donahue
authors.affiliation: Office of Health Insurance Programs, New York State Department of Health, Albany, New York.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Bass
authors.affiliation: Heart and Vascular Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Gary
authors.initials: G
authors.lastname: Walford
authors.affiliation: Department of Cardiology, Boston Medical Center, Boston, Massachusetts.
authors.forename: Alice K
authors.initials: AK
authors.lastname: Jacobs
authors.affiliation: Department of Cardiology, Albany Medical Center, Albany, New York.
authors.forename: Ferdinand J
authors.initials: FJ
authors.lastname: Venditti
authors.affiliation: Department of Cardiology, Campbell County Memorial Hospital, Gillette, Wyoming.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Stamato
authors.affiliation: Department of Cardiology, Northwell Health, Great Neck, New York.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.affiliation: Clinical Cardiology, Mt. Sinai Medical Center, New York, New York.
authors.forename: Samin
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Academic Affairs, St. Joseph's Health System, Atlanta, Georgia.
authors.forename: Spencer B
authors.initials: SB
authors.lastname: King
mesh_terms: D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies
keywords: Medicaid; Percutaneous Coronary Interventions Reporting System; revascularization; stable coronary artery disease