Public outcomes reporting tied to lower PCI rates for acute MI
Stephen W. Waldo, M.D., from Massachusetts General Hospital in Boston, and colleagues evaluated the association between public reporting with procedural management and outcomes among AMI patients using data from the Nationwide Inpatient Sample. Comparisons were made between patients in public reporting states (Massachusetts and New York; 57,629 patients) and those in regionally comparable states without public reporting (Connecticut, Maine, Maryland, New Hampshire, Rhode Island, and Vermont; 26,492 patients) from 2005 to 2011.
The researchers found that percutaneous revascularization was performed less often in public reporting states than in nonreporting states (odds ratio [OR], 0.81), especially among older patients (OR, 0.75), those with Medicare insurance (OR, 0.75), and those presenting with ST-segment elevation MI (OR, 0.63). Overall, there were higher adjusted in-hospital mortality rates among patients with AMI in public reporting states (OR, 1.21), compared to those in nonreporting states, although this was predominately seen in patients who did not receive percutaneous revascularization in public reporting states (adjusted OR, 1.30).
"It is troubling to face the possibility that public reporting of outcome data for percutaneous coronary intervention might, in fact, be associated with the unintended consequence of lower percutaneous coronary intervention rates in this patient population and in what could be potentially considered a deviation from the standard of care, resulting in worse outcomes," writes the author of an accompanying editorial.
One author disclosed financial ties to the medical device industry.
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