Author + information
- Received August 31, 2016
- Revision received October 31, 2016
- Accepted October 31, 2016
- Published online February 6, 2017.
- Edward L. Hannan, PhDa,∗ (, )
- Ye Zhong, MDa,
- Kimberly Cozzens, MAa,
- Foster Gesten, MDb,
- Marcus Friedrich, MDb,
- Peter B. Berger, MDc,
- Alice K. Jacobs, MDd,
- Gary Walford, MDe,
- Frederick S.K. Ling, MDf,
- Ferdinand J. Venditti, MDg and
- Spencer B. King III, MDh
- aUniversity at Albany, State University of New York, Albany, New York
- bNew York State Department of Health, Albany, New York
- cNorthwell Health, Great Neck, New York
- dBoston Medical Center, Boston, Massachusetts
- eJohns Hopkins University, Baltimore, Maryland
- fUniversity of Rochester Medical Center, Rochester, New York
- gAlbany Medical Center, Albany, New York
- hSt. Joseph’s Health System, Atlanta, Georgia
- ↵∗Address for correspondence:
Dr. Edward L. Hannan, School of Public Health, State University of New York, University at Albany, One University Place, Rensselaer, New York 12144-3456.
Objectives The authors examined the impact of including shock patients in public reporting of percutaneous coronary intervention (PCI) risk-adjusted mortality.
Background There is concern that an unintended consequence of statewide public reporting of medical outcomes is the avoidance of appropriate interventions for high-risk patients.
Methods New York State’s PCI registry was used to compare hospital and physician risk-adjusted mortality rates and outliers from New York’s public report models with rates and outliers based on statistical models that include refractory shock patients and exclude both refractory shock and other shock patients.
Results Correlations between the public report model and each of the other 2 models were above 0.92 for hospital risk-adjusted rates and were 0.99 for all physician risk-adjusted rates (p < 0.0001). There were 11 physicians with lower than expected mortality rates (low outliers) and 41 physicians with higher than expected mortality rates (high outliers) across the 3 time periods in the public report, compared with 10 low outliers and 40 high outliers if all shock patients had been excluded. There was considerable overlap among outliers identified by the 3 models. Findings were similar for hospital outliers.
Conclusions Risk-adjusted hospital and physician mortality rates are highly correlated regardless of whether shock patients are included in public reporting. The numbers of outliers are similar, and outlier changes are minimal, although 10% to 15% of cardiologists who were outliers in either exclusion rule were not outliers in the other one. This information can form a basis for subsequent discussions regarding the exclusion of high-risk patients from public reporting.
Dr. Berger is a consultant for a National Quality Initiative not related to this study. Dr. Jacobs is a site principal investigator for Abbott Vascular and AstraZeneca. Dr. King is a member of the Data Safety Monitoring Board for Harvard Clinical Research Institute, Duke University, Capicor, Inc., Merck & Co, and Stentys. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 31, 2016.
- Revision received October 31, 2016.
- Accepted October 31, 2016.
- American College of Cardiology Foundation