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Shah T, Nathan A. Considering Initial "PCI Turndown" as a Risk Factor for Subsequent PCI. J Am Heart Assoc 2024; 13:e035891. [PMID: 38818930 DOI: 10.1161/jaha.124.035891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Affiliation(s)
- Tayyab Shah
- Hospital of the University of Pennsylvania Philadelphia PA USA
| | - Ashwin Nathan
- Hospital of the University of Pennsylvania Philadelphia PA USA
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2
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Wang C, Lindquist K, Krumholz H, Hsia RY. Trends in the likelihood of receiving percutaneous coronary intervention in a low-volume hospital and disparities by sociodemographic communities. PLoS One 2023; 18:e0279905. [PMID: 36652416 PMCID: PMC9847957 DOI: 10.1371/journal.pone.0279905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/17/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Over the past two decades, percutaneous coronary intervention (PCI) capacity has increased while coronary artery disease has decreased, potentially lowering per-hospital PCI volumes, which is associated with less favorable patient outcomes. Trends in the likelihood of receiving PCI in a low-volume center have not been well-documented, and it is unknown whether certain socioeconomic factors are associated with a greater risk of PCI in a low-volume facility. Our study aims to determine the likelihood of being treated in a low-volume PCI center over time and if this likelihood differs by sociodemographic factors. METHODS We conducted a retrospective cohort study of 374,066 hospitalized patients in California receiving PCI from January 1, 2010, to December 31, 2018. Our primary outcome was the likelihood of PCI discharges at a low-volume hospital (<150 PCI/year), and secondary outcomes included whether this likelihood varied across different sociodemographic groups and across low-volume hospitals stratified by high or low ZIP code median income. RESULTS The proportion of PCI discharges from low-volume hospitals increased from 5.4% to 11.0% over the study period. Patients of all sociodemographic groups considered were more likely to visit low-volume hospitals over time (P<0.001). Latinx patients were more likely to receive PCI at a low-volume hospital compared with non-Latinx White in 2010 with a 166% higher gap in 2018 (unadjusted proportions). The gaps in relative risk (RR) between Black, Latinx and Asian patients versus non-Latinx white increased over time, whereas the gap between private versus public/no insurance, and high versus low income decreased (interaction P<0.001). In low-income ZIP codes, patients with Medicaid were less likely to visit low-volume hospitals than patients with private insurance in 2010; however, this gap reversed and increased by 500% in 2018. Patients with low income were more likely to receive PCI at low-volume hospitals relative to patients with high income in all study years. CONCLUSIONS The likelihood of receiving PCI at low-volume hospitals has increased across all race/ethnicity, insurance, and income groups over time; however, this increase has not occurred evenly across all sociodemographic groups.
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Affiliation(s)
- Christina Wang
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Karla Lindquist
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Harlan Krumholz
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Renee Y. Hsia
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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3
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Joynt Maddox KE, Orav EJ, Zheng J, Epstein AM. Medicare’s Bundled Payments For Care Improvement Advanced Model: Impact On High-Risk Beneficiaries. Health Aff (Millwood) 2022; 41:1661-1669. [DOI: 10.1377/hlthaff.2022.00138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - E. John Orav
- E. John Orav, Harvard University and Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Arnold M. Epstein
- Arnold M. Epstein, Harvard University and Brigham and Women’s Hospital
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4
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Muacevic A, Adler JR. Strong Public Desire for Quality and Price Transparency in Shoulder Arthroplasty. Cureus 2022; 14:e30396. [PMID: 36407272 PMCID: PMC9668540 DOI: 10.7759/cureus.30396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Concerted efforts to optimize outcomes and data transparency in shoulder arthroplasty have led to the creation of the American Academy of Orthopaedic Surgeons (AAOS) Shoulder and Elbow Registry, the first nationwide registry of its kind. We used online crowdsourcing to explore the general public's perceptions and beliefs toward the disclosure of quality and price data in shoulder arthroplasty. METHODS A total of 498 participants recruited using Amazon Mechanical Turk (MTurk) completed a survey regarding beliefs about public disclosure of quality and price data in shoulder arthroplasty. The MTurk is an online marketplace for crowdsourcing tasks (e.g., answering surveys) to a pool of over 500,000 registered workers in exchange for financial compensation. Requesters post human-intelligence tasks, and workers can respond to those that they are interested in completing. This web-based platform is an efficient survey tool for medical research, with comparable national representativeness to traditional convenience samples. RESULTS The majority (95%) of respondents believed surgeons and hospitals should share their data with national registries such as the AAOS Shoulder and Elbow Registry. Most believed that patients considering shoulder arthroplasty should have public access to surgeons' outcomes and complication rates (96%), years of experience (95%), and case volume (92%). Most respondents desired price transparency in implant costs (95%), surgeon reimbursement (80%), and hospital reimbursement (84%). In decreasing order of importance, the top three factors guiding surgeon choice were: (1) surgeon included in the insurer's network, (2) annual case volume, and (3) publicly available outcomes. CONCLUSION Increased quality and price transparency in shoulder arthroplasty may empower patients to make better-informed decisions about their care and ultimately enhance value. Given the strong public desire for data transparency and the notion that public disclosure of data is intrinsically associated with performance improvement, surgeons and hospitals should strongly consider submitting their data to national registries such as the AAOS Shoulder and Elbow Registry.
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5
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Bryan AF, Nair-Desai S, Tsai TC. The Need for a Better-Quality Reporting System for Ambulatory and Outpatient Surgery-Surgical Quality Without Walls. JAMA Surg 2022; 157:753-754. [PMID: 35767275 DOI: 10.1001/jamasurg.2022.0680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ava Ferguson Bryan
- Department of Surgery, University of Chicago, Chicago, Illinois.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Thomas C Tsai
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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6
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Timmermans MJC, Houterman S, Daeter ED, Danse PW, Li WW, Lipsic E, Roefs MM, van Veghel D. Using real-world data to monitor and improve quality of care in coronary artery disease: results from the Netherlands Heart Registration. Neth Heart J 2022; 30:546-556. [PMID: 35389133 PMCID: PMC8988537 DOI: 10.1007/s12471-022-01672-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
Worldwide, quality registries for cardiovascular diseases enable the use of real-world data to monitor and improve the quality of cardiac care. In the Netherlands Heart Registration (NHR), cardiologists and cardiothoracic surgeons register baseline, procedural and outcome data across all invasive cardiac interventional, electrophysiological and surgical procedures. This paper provides insight into the governance and processes as organised by the NHR in collaboration with the hospitals. To clarify the processes, examples are given from the percutaneous coronary intervention and coronary artery bypass grafting registries. Physicians who are mandated by their hospital to instruct the NHR to process their data are united in registration committees. The committees determine standard sets of variables and periodically discuss the completeness and quality of data and patient-relevant outcomes. In the case of significant variation in outcomes, processes of healthcare delivery are discussed and good practices are shared in a non-competitive and safe setting. To create new insights for further improvement in patient-relevant outcomes, quality projects are initiated on, for example, multivessel disease treatment, cardiogenic shock and diagnostic intracoronary procedures. Moreover, possibilities are explored to expand the quality registries through additional relevant indicators, such as resource use before and after the procedure, by enriching NHR data with other existing data resources.
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Affiliation(s)
| | | | - Edgar D Daeter
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Peter W Danse
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Wilson W Li
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Erik Lipsic
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Maaike M Roefs
- Netherlands Heart Registration, Utrecht, The Netherlands
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7
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Public Reporting on the Quality of Care in Patients with Acute Myocardial Infarction: The Korean Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063169. [PMID: 35328856 PMCID: PMC8955521 DOI: 10.3390/ijerph19063169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 02/04/2023]
Abstract
Public reporting is a way to promote quality of healthcare. However, evidence supporting improved quality of care using public reporting in patients with acute myocardial infarction (AMI) is disputed. This study aims to describe the impact of public reporting of AMI care on hospital quality improvement in Korea. Patients with AMI admitted to the emergency room with ICD-10 codes of I21.0 to I21.9 as the primary or secondary diagnosis were identified from the national health insurance claims data (2007-2012). Between 2007 and 2012, 43,240/83,378 (51.9%) patients manifested ST segment elevation myocardial infarction (STEMI). Timely reperfusion rate increased (β = 2.78, p = 0.001). The mortality rate of STEMI patients was not changed (β = -0.0098, p = 0.384) but that of NSTEMI patients decreased (β = -0.465, p = 0.001). Public reporting has a substantial impact on the process indicators of AMI in Korea because of the increased reperfusion rate. However, the outcome indicators such as mortality did not significantly change, suggesting that public reporting did not necessarily improve the quality of care.
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8
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Sherwood MW, Vora AN. For TAVR, Home Is Where the Heart Is. J Am Coll Cardiol 2022; 79:145-147. [PMID: 35027109 DOI: 10.1016/j.jacc.2021.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Matthew W Sherwood
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA; Duke University Clinical Research Institute, Durham, North Carolina, USA.
| | - Amit N Vora
- University of Pennsylvania Medical Center Heart and Vascular Institute, Harrisburg, Pennsylvania, USA; Duke University Medical Center, Durham, North Carolina, USA
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9
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Thompson MP, Hou H, Brescia AA, Pagani FD, Sukul D, McCullough JS, Likosky DS. Center Variability in Medicare Claims-Based Publicly Reported Transcatheter Aortic Valve Replacement Outcome Measures. J Am Heart Assoc 2021; 10:e021629. [PMID: 34689581 PMCID: PMC8751838 DOI: 10.1161/jaha.121.021629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Public reporting of transcatheter aortic valve replacement (TAVR) claims–based outcome measures is used to identify high‐ and low‐performing centers. Whether claims‐based TAVR outcomes can reliably be used for center‐level comparisons is unknown. In this study, we sought to evaluate center variability in claims‐based TAVR outcomes used in public reporting. Methods and Results The study sample included 119 554 Medicare beneficiaries undergoing TAVR between January 2014 and October 2018 based on procedure codes in 100% Medicare inpatient claims. Multivariable hierarchical logistic regression was used to estimate center‐specific adjusted rates and reliability (R) of 30‐day mortality, discharge not to home/self‐care, 30‐day stroke, and 30‐day readmission. Reliability was defined as the ratio of between‐hospital variation to the sum of the between‐ and within‐hospital variation. The median (interquartile range [IQR]) center‐level adjusted outcome rates were 3.1% (2.9%–3.4%) for 30‐day mortality, 41.4% (31.3%–53.4%) for discharge not to home, 2.5% (2.3%–2.7%) for 30‐day stroke, and 14.9% (14.4%–15.5%) for 30‐day readmission. Median reliability was highest for the discharge not to home measure (R=0.95; IQR, 0.94–0.97), followed by the 30‐day stroke (R=0.92; IQR, 0.87–0.94), 30‐day mortality (R=0.86; IQR, 0.81–0.91), and 30‐day readmission measures (R=0.42; IQR, 0.35–0.51). Across outcomes, there was an inverse relationship between center volume and measure reliability. Conclusions Claims‐based TAVR outcome measures for mortality, discharge not to home, and stroke were reliable measures for center‐level comparisons, but readmission measures were unreliable. Stakeholders should consider these findings when evaluating claims‐based measures to compare center‐level TAVR performance.
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Affiliation(s)
- Michael P Thompson
- Department of Cardiac Surgery Michigan Medicine Ann Arbor MI.,Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Hechuan Hou
- Department of Cardiac Surgery Michigan Medicine Ann Arbor MI
| | - Alexander A Brescia
- Department of Cardiac Surgery Michigan Medicine Ann Arbor MI.,Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Francis D Pagani
- Department of Cardiac Surgery Michigan Medicine Ann Arbor MI.,Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Devraj Sukul
- Division of Cardiovascular Medicine Department of General Internal Medicine Michigan Medicine Ann Arbor MI
| | - Jeffrey S McCullough
- Department of Health Management and Policy School of Public Health University of Michigan Ann Arbor MI
| | - Donald S Likosky
- Department of Cardiac Surgery Michigan Medicine Ann Arbor MI.,Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
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10
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Nguyen DD, Doll JA. Quality Improvement and Public Reporting in STEMI Care. Interv Cardiol Clin 2021; 10:391-400. [PMID: 34053625 DOI: 10.1016/j.iccl.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mortality rates for patients with ST-segment elevation myocardial infarction (STEMI) remain high despite development of novel drugs and interventions over the past several decades. There is significant variability between hospitals in use of evidence-based treatments, and substantial opportunities exist to optimize care pathways and reduce disparities in care delivery. Quality improvement interventions implemented at local, regional, and national levels have improved care processes and patient outcomes. This article reviews evidence for quality improvement interventions along the spectrum of STEMI care, describes existing systems for quality measurement, and examines local and national policy interventions, with special attention to public reporting programs.
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Affiliation(s)
- Dan D Nguyen
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Jacob A Doll
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA; VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA.
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11
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Van Wilder A, Bruyneel L, De Ridder D, Seys D, Brouwers J, Claessens F, Cox B, Vanhaecht K. Is a hospital quality policy based on a triad of accreditation, public reporting and inspection evidence-based? A narrative review. Int J Qual Health Care 2021; 33:6278849. [PMID: 34013956 DOI: 10.1093/intqhc/mzab085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/02/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Since 2009, hospital quality policy in Flanders, Belgium, is built around a quality-of-care triad, which encompasses accreditation, public reporting (PR) and inspection. Policy makers are currently reflecting on the added value of this triad. METHODS We performed a narrative review of the literature published between 2009 and 2020 to examine the evidence base of the impact accreditation, PR and inspection, both individually and combined, has on patient processes and outcomes. The following patient outcomes were examined: mortality, length of stay, readmissions, patient satisfaction, adverse outcomes, failure to rescue, adherence to process measures and risk aversion. The impact of accreditation, PR and inspection on these outcomes was evaluated as either positive, neutral (i.e. no impact observed or mixed results reported) or negative. OBJECTIVES To assess the current evidence base on the impact of accreditation, PR and inspection on patient processes and outcomes. RESULTS We identified 69 studies, of which 40 were on accreditation, 24 on PR, three on inspection and two on accreditation and PR concomitantly. Identified studies reported primarily low-level evidence (level IV, n = 53) and were heterogeneous in terms of implemented programmes and patient populations (often narrow in PR research). Overall, a neutral categorization was determined in 30 articles for accreditation, 23 for PR and four for inspection. Ten of these recounted mixed results. For accreditation, a high number (n = 12) of positive research on adherence to process measures was discovered. CONCLUSION The individual impact of accreditation, PR and inspection, the core of Flemish hospital quality, was found to be limited on patient outcomes. Future studies should investigate the combined effect of multiple quality improvement strategies.
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Affiliation(s)
- Astrid Van Wilder
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium.,Department of Quality Improvement, University Hospitals Leuven, Herestraat 49, Leuven, Vlaams-Brabant 3000, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium.,Department of Urology, University Hospitals Leuven, Belgium, Herestraat 49, Leuven, Vlaams-Brabant 3000, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium.,Department of Quality Improvement, University Hospitals Leuven, Herestraat 49, Leuven, Vlaams-Brabant 3000, Belgium
| | - Jonas Brouwers
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium
| | - Fien Claessens
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium
| | - Bianca Cox
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3rd floor, box 3001, Leuven, Vlaams-Brabant 3000, Belgium.,Department of Quality Improvement, University Hospitals Leuven, Herestraat 49, Leuven, Vlaams-Brabant 3000, Belgium
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12
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Predicting In-Hospital Mortality in Patients Undergoing Percutaneous Coronary Intervention. J Am Coll Cardiol 2021; 78:216-229. [PMID: 33957239 DOI: 10.1016/j.jacc.2021.04.067] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Standardization of risk is critical in benchmarking and quality improvement efforts for percutaneous coronary interventions (PCIs). In 2018, the CathPCI Registry was updated to include additional variables to better classify higher-risk patients. OBJECTIVES This study sought to develop a model for predicting in-hospital mortality risk following PCI incorporating these additional variables. METHODS Data from 706,263 PCIs performed between July 2018 and June 2019 at 1,608 sites were used to develop and validate a new full and pre-catheterization model to predict in-hospital mortality, and a simplified bedside risk score. The sample was randomly split into a development cohort (70%, n = 495,005) and a validation cohort (30%, n = 211,258). The authors created 1,000 bootstrapped samples of the development cohort and used stepwise selection logistic regression on each sample. The final model included variables that were selected in at least 70% of the bootstrapped samples and those identified a priori due to clinical relevance. RESULTS In-hospital mortality following PCI varied based on clinical presentation. Procedural urgency, cardiovascular instability, and level of consciousness after cardiac arrest were most predictive of in-hospital mortality. The full model performed well, with excellent discrimination (C-index: 0.943) in the validation cohort and good calibration across different clinical and procedural risk cohorts. The median hospital risk-standardized mortality rate was 1.9% and ranged from 1.1% to 3.3% (interquartile range: 1.7% to 2.1%). CONCLUSIONS The risk of mortality following PCI can be predicted in contemporary practice by incorporating variables that reflect clinical acuity. This model, which includes data previously not captured, is a valid instrument for risk stratification and for quality improvement efforts.
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13
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Zhang Z, Bai J, Huang Y, Wang L. Implementation of a clinical nursing pathway for percutaneous coronary intervention: A randomized controlled trial protocol. Medicine (Baltimore) 2020; 99:e22866. [PMID: 33120826 PMCID: PMC7581146 DOI: 10.1097/md.0000000000022866] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Acute myocardial infarction is a very common disease in the emergency room. Emergency percutaneous coronary intervention (PCI) is the first choice to open infarct-related artery in time to regain the active blood flow of myocardial tissue. Clinical nursing pathway (CNP), namely clinical project, is an original nursing mode with good quality, outstanding efficiency, and low treatment spending, so it has attracted more and more attention. However, few studies have reported the implementation of a CNP in PCIs. The purpose of the protocol is to assess the impact of CNP on the clinical efficacy of transradial emergency PCI. METHODS This is a randomized controlled, single center trial which will be implemented from January 2021 to June 2021. Hundred samples diagnosed with acute myocardial infarction will be included in this study. It was authorized via the Ethics Committee of Changshan County People's Hospital (CCPH002348). Patients are assigned to the following groups: control group, given normal routine care; CNP group, treated with CNP plan. The time from door to balloon, hospitalization expenses, length of stay, postoperative complications, patients' satisfaction with treatment are compared and analyzed. All data are collected and analyzed by Social Sciences software version 21.0 (SPSS, Inc., Chicago, IL) program. RESULTS Differences of clinical outcomes between groups (). CONCLUSION This original evidence-based nursing model can be used as the foundation for further research. TRIAL REGISTRATION NUMBER researchregistry6030.
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Affiliation(s)
| | | | | | - Lingling Wang
- Department of Radiology, Changshan County People's Hospital, Zhejiang, China
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14
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Hannan EL, Zhong Y, Ling FSK, Tamis-Holland J, Berger PB, Jacobs AK, Walford G, Venditti FJ, King SB. Assessment of repeat target lesion percutaneous coronary intervention as a quality measure for public reporting and general quality assessment for PCIs. Catheter Cardiovasc Interv 2020; 96:731-740. [PMID: 31642597 DOI: 10.1002/ccd.28526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/30/2019] [Accepted: 09/18/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Target lesion percutaneous coronary intervention (TLPCI) within 1 year of PCI has been proposed by critics of public reporting of short-term mortality as an alternative measure for PCI reporting. METHODS New York's PCI registry was used to identify 1-year repeat TLPCI and 1-year repeat TLPCI/mortality for patients discharged between December 1, 2013 and November 30, 2014. Significant independent predictors of the outcomes were identified. Hospital and cardiologist risk-adjusted outcomes were calculated, and outlier status and correlations of risk-adjusted rates were examined for the three outcomes. RESULTS The adverse outcome rates were 1.30, 4.21, and 8.97% for in-hospital/30-day mortality, 1-year repeat TLPCI, and 1-year repeat TLPCI/mortality. There were many commonalities but also many differences in significant predictors of the outcomes. Hospital and cardiologist risk-adjusted 1-year repeat TLPCI rates and repeat TLPCI/mortality rates were poorly correlated with risk-adjusted in-hospital/30-day mortality rates (eg, Spearman R = -.16 [p = .23] and .27 [p = .04], respectively, for hospital 1-year repeat TLPCI vs. in-hospital/30-day mortality). Many more providers were found to have significantly higher and lower rates for repeat TLPCI than for short-term mortality. CONCLUSIONS Hospital and cardiologist quality assessments are very different for TLPCI and repeat TLPCI/mortality than they are for short-term mortality. Repeat TLPCI/mortality rates are highly correlated with repeat TLPCI rates, but outlier providers differ. More study of repeat TLPCI and all the patient, cardiologist, and hospital factors associated with it may be required before using it as a supplement to, or in lieu of, short-term mortality in public reporting of PCI outcomes.
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Affiliation(s)
- Edward L Hannan
- Department of Health Policy, Management and Behavior, University at Albany, State University of New York, Albany, New York
| | - Ye Zhong
- Research Foundation, University at Albany, State University of New York, Albany, New York
| | - Frederick S K Ling
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | | | | | - Alice K Jacobs
- Department. of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Gary Walford
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Spencer B King
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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15
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Public Reporting of Cardiac Outcomes for Patients With Acute Myocardial Infarction: A Systematic Review of the Evidence. J Cardiovasc Nurs 2020; 34:115-123. [PMID: 30211816 DOI: 10.1097/jcn.0000000000000524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is recognized by both the American Heart Association and the American College of Cardiology as an optimal therapy to treat patients experiencing acute myocardial infarction (AMI) with ST-segment elevation myocardial infarction. A health policy aimed at improving outcomes for the patient with AMI is public reporting of whether a patient received a PCI. OBJECTIVE A systematic review was conducted to evaluate the effect of public reporting for patients with AMI, specifically for those patients who receive PCI. METHODS EMBASE, MEDLINE, Academic Search Premier, Google Scholar, and PubMed were searched from inception through August 2017. Articles were selected for inclusion if researchers evaluated public reporting and included an outcome for whether a patient received a PCI during hospitalization for an AMI. Methodological quality of the included studies was evaluated, and findings were synthesized. RESULTS Eight studies of high methodological quality were included in the review. Most studies found that, in areas of public reporting, patients were less likely to undergo a PCI and high-risk patients did not undergo a PCI. Researchers also found that patients with AMI had lower in-hospital mortality after the implementation of public reporting, but only if these patients received a PCI. CONCLUSIONS Although public reporting may have had intentions of improving care, there is strong evidence that this policy did not result in more timely PCIs or improved mortality of patients with AMI. In fact, public reporting resulted in unintended consequences of not providing care for the most vulnerable patients in fear of an adverse outcome.
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Omer MA, Tyler JM, Henry TD, Garberich R, Sharkey SW, Schmidt CW, Henry JT, Eckman P, Megaly M, Brilakis ES, Chavez I, Burke N, Gössl M, Mooney M, Sorajja P, Traverse JH, Wang Y, Hryniewicz K, Garcia S. Clinical Characteristics and Outcomes of STEMI Patients With Cardiogenic Shock and Cardiac Arrest. JACC Cardiovasc Interv 2020; 13:1211-1219. [DOI: 10.1016/j.jcin.2020.04.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 12/22/2022]
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17
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Metkus T, Miller PE, Alviar CL, Jentzer JC, van Diepen S, Katz JN, Morrow DA, Schulman S, Eid S. Incidence, predictors and prognosis of respiratory support in non-ST segment elevation myocardial infarction. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2020; 10:2048872620919947. [PMID: 32324057 DOI: 10.1177/2048872620919947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/26/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND The incidences of invasive mechanical ventilation and non-invasive ventilation among patients with non-ST segment elevation myocardial infarction and associated prognosis are not well characterized. METHODS We conducted a retrospective cohort study of patients with admission diagnosis of non-ST segment elevation myocardial infarction using the US National Inpatient Sample database between 2002-2014. The exposure variable was invasive mechanical ventilation or non-invasive ventilation within 24 h of admission, compared to no respiratory support. The primary outcome was in-hospital mortality. We determined the association between respiratory support and mortality using Cox proportional hazard models. RESULTS A total of 4,152,421 non-ST segment elevation myocardial infarction hospitalizations were identified, among whom 1.3% required non-invasive ventilation and 1.9% required invasive mechanical ventilation. Non-invasive ventilation use increased over time (0.4% in 2002 to 2.4% in 2014, p<0.001) while there was no definite trend in invasive mechanical ventilation use. Revascularization was lower for non-ST segment elevation myocardial infarction hospitalizations including invasive mechanical ventilation (23.9%) and non-invasive ventilation (14.5%) compared to 36.5% of those without respiratory support (p<0.001). In-hospital mortality was 3.1% for non-ST segment elevation myocardial infarction without respiratory support compared to 9.2% with non-invasive ventilation (adjusted hazard ratio 1.86, 95% confidence interval 1.74-1.98) and 37.2% with invasive mechanical ventilation (adjusted hazard ratio 3.03, 95% confidence interval 2.88-3.19). Mortality for non-ST segment elevation myocardial infarction-non-invasive ventilation is improving over time while mortality for non-ST segment elevation myocardial infarction-invasive mechanical ventilation is increasing over time. CONCLUSION Mechanical respiratory support in non-ST segment elevation myocardial infarction is used in an important minority of cases, is increasing and is independently associated with mortality. Studies of the optimal management of acute coronary syndrome complicated by respiratory failure are needed to improve outcomes.
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Affiliation(s)
- Thomas Metkus
- Department of Medicine, Johns Hopkins University School of Medicine, USA
| | - P Elliott Miller
- Department of Cardiovascular Medicine, Yale School of Medicine, USA
| | - Carlos L Alviar
- Leon H. Charney Division of Cardiology, New York University School of Medicine, USA
| | | | - Sean van Diepen
- Department of Critical Care and Division of Cardiology and Department of Medicine, University of Alberta Canada
| | - Jason N Katz
- Division of Cardiology, Duke University, Durham, NC USA
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David A Morrow
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven Schulman
- Department of Medicine, Johns Hopkins University School of Medicine, USA
| | - Shaker Eid
- Department of Medicine, Johns Hopkins University School of Medicine, USA
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18
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Garcia S, Schmidt CW, Garberich R, Henry TD, Bradley SM, Brilakis ES, Burke N, Chavez IJ, Eckman P, Gössl M, Mooney MR, Newell MC, Poulose AK, Sorajja P, Traverse JH, Wang YL, Sharkey SW. Temporal changes in patient characteristics and outcomes in ST-segment elevation myocardial infarction 2003-2018. Catheter Cardiovasc Interv 2020; 97:1109-1117. [PMID: 32294799 DOI: 10.1002/ccd.28901] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/29/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND We sought to describe changes in demographic variables, process of care measures, and outcomes of patients treated in a regional ST-segment elevation myocardial infarction (STEMI) program over the last 15 years. METHODS We describe demographic variables, process of care measures, and outcomes of patients treated in the program in various 5-year time periods: 2003-2007 (n = 1,821), 2008-2012 (n = 1,968), and 2013-2018 (n = 2,223). The primary outcome measures were in-hospital and 30-day mortality. RESULTS Among 6,012 STEMI patients treated from 2003 to 2018 we observed a significant increase in mean age at presentation (62 ± 14 to 64 ± 13 years) and diabetes (14-22%, p < .01). The proportion of patients with cardiogenic shock (CS) and cardiac arrest (CA) pre-PCI increased significantly from 9.5% to 11.1% and 8.5% to 12.7% (p < .05), respectively. The median door-to-balloon (D2B) times decreased from 98 to 93 min and total ischemic time decreased from 202 to 185 min (all p < .05). Despite increased patient complexity, the proportion of nontransfer and transfer patients achieving D2B times consistent with guideline recommendations remained unchanged (for nontransfer patients 79-82%, p = .45 and for transfer patients 65-64%, p = .34). Among all STEMI patients, in-hospital mortality increased during the study period from 4.9 to 6.9% (p = .007) but remained stable (<2%) when CA and CS patients were excluded. CONCLUSIONS Over the last 15 years, short-term STEMI mortality has increased despite improvements in care delivery metrics. Patients with CA and/or CS now represent 10% of STEMI patients and are responsible for 80% of deaths. Therefore, efforts to improve STEMI mortality, and metrics for assessing STEMI programs, should focus on these patients.
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Affiliation(s)
- Santiago Garcia
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Christian W Schmidt
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ross Garberich
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio, USA
| | - Steven M Bradley
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Nickolas Burke
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ivan J Chavez
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Peter Eckman
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Mario Gössl
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michael R Mooney
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Marc C Newell
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Anil K Poulose
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Jay H Traverse
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yale L Wang
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Scott W Sharkey
- Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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19
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Strom JB, Zhao Y, Shen C, Chung M, Pinto DS, Popma JJ, Cohen DJ, Yeh RW. Hospital Variation in the Utilization of Short-Term Nondurable Mechanical Circulatory Support in Myocardial Infarction Complicated by Cardiogenic Shock. Circ Cardiovasc Interv 2020; 12:e007270. [PMID: 30608880 DOI: 10.1161/circinterventions.118.007270] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Limited knowledge exists on inter-hospital variation in the utilization of short-term, nondurable mechanical circulatory support (MCS) for myocardial infarction (MI) complicated by cardiogenic shock (CS). METHODS AND RESULTS Hospitalizations for MI with CS in 2014 in a nationally representative all-payer database were included. The proportion of hospitalizations for MI with CS using MCS (MCS ratio) and in-hospital mortality were evaluated. Hospital characteristics and outcomes were compared across quartiles of MCS usage. Of 1813 hospitals evaluated, 1440 (79.4%) performed ≥10 percutaneous coronary interventions annually. Of these, 1064 (73.9%) had at least one code for MCS. Forty-one percent of hospitals did not use MCS. The median (interquartile range) proportion of MCS use among admissions for MI with CS was 33.3% (0.0%-50.0%). High MCS utilizing hospitals were larger ( P<0.001). Eighty-five percent (2808/3301) of MCS use was intra-aortic balloon pump. There was significant variation in receipt of MCS at different hospitals (median odds ratio of receiving MCS at 2 random hospitals: 1.58; 95% CI, 1.45-1.70). Adjusted in-hospital mortality was not different across quartiles of MCS use (Q4 versus Q1; odds ratio, 0.95; 95% CI, 0.77-1.16; P=0.58). CONCLUSIONS Wide variation exists in hospital use of MCS for MI with CS, unexplained by patient characteristics. The predominant form of MCS use is intra-aortic balloon pump. Risk-adjusted mortality rates were not different between higher and lower MCS-utilizing hospitals.
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Affiliation(s)
- Jordan B Strom
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.B.S., Y.Z., C.S., M.C., D.S.P., J.J.P., R.W.Y.)
| | - Yuansong Zhao
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.B.S., Y.Z., C.S., M.C., D.S.P., J.J.P., R.W.Y.)
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.B.S., Y.Z., C.S., M.C., D.S.P., J.J.P., R.W.Y.)
| | - Mabel Chung
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.B.S., Y.Z., C.S., M.C., D.S.P., J.J.P., R.W.Y.).,Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston (M.C.)
| | - Duane S Pinto
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.B.S., Y.Z., C.S., M.C., D.S.P., J.J.P., R.W.Y.)
| | - Jeffrey J Popma
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.B.S., Y.Z., C.S., M.C., D.S.P., J.J.P., R.W.Y.)
| | - David J Cohen
- Saint Luke's Mid-America Heart Institute, Department of Medicine, Division of Cardiology, University of Missouri-Kansas City School of Medicine (D.J.C.)
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.B.S., Y.Z., C.S., M.C., D.S.P., J.J.P., R.W.Y.)
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20
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Association between Public Reporting of Outcomes and the Use of Mechanical Circulatory Support in Patients with Cardiogenic Shock. J Interv Cardiol 2019; 2019:3276521. [PMID: 31772523 PMCID: PMC6766255 DOI: 10.1155/2019/3276521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/15/2019] [Accepted: 08/23/2019] [Indexed: 11/17/2022] Open
Abstract
Risk-averse behavior has been reported among physicians and facilities treating cardiogenic shock in states with public reporting. Our objective was to evaluate if public reporting leads to a lower use of mechanical circulatory support in cardiogenic shock. We conducted a retrospective study with the use of the National Inpatient Sample from 2005 to 2011. Hospitalizations of patients ≥18 years old with a diagnosis of cardiogenic shock were included. A regional comparison was performed to identify differences between reporting and nonreporting states. The main outcome of interest was the use of mechanical circulatory support. A total of 13043 hospitalizations for cardiogenic shock were identified of which 9664 occurred in reporting and 3379 in nonreporting states (age 69.9 ± 0.4 years, 56.8% men). Use of mechanical circulatory support was 32.8% in this high-risk population. Odds of receiving mechanical circulatory support were lower (OR 0.50; 95% CI 0.43-0.57; p < 0.01) and in-hospital mortality higher (OR 1.19; 95% CI 1.06-1.34; p < 0.01) in reporting states. Use of mechanical circulatory support was also lower in the subgroup of patients with acute myocardial infarction and cardiogenic shock in reporting states (OR 0.61; 95% CI 0.51-0.72; p < 0.01). In conclusion, patients with cardiogenic shock in reporting states are less likely to receive mechanical circulatory support than patients in nonreporting states.
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21
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Affiliation(s)
- Lawrence P Casalino
- Division of Health Policy and Economics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Dhruv Khullar
- Departments of Healthcare Policy and Research and Medicine, Weill Cornell Medical College, New York, New York
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22
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Sandhu AT, Kohsaka S, Bhattacharya J, Fearon WF, Harrington RA, Heidenreich PA. Association Between Current and Future Annual Hospital Percutaneous Coronary Intervention Mortality Rates. JAMA Cardiol 2019; 4:1077-1083. [PMID: 31532454 DOI: 10.1001/jamacardio.2019.3221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Multiple states publicly report a hospital's risk-adjusted mortality rate for percutaneous coronary intervention (PCI) as a quality measure. However, whether reported annual PCI mortality is associated with a hospital's future performance is unclear. Objective To evaluate the association between reported risk-adjusted hospital PCI-related mortality and a hospital's future PCI-related mortality. Design, Setting, and Participants This study used data from the New York Percutaneous Intervention Reporting System from January 1, 1998, to December 31, 2016, to assess hospitals that perform PCI. Exposures Public-reported, risk-adjusted, 30-day mortality after PCI. Main Outcomes and Measures The primary analysis evaluated the association between a hospital's reported risk-adjusted PCI-related mortality and future PCI-related mortality. The correlation between a hospital's observed to expected (O/E) PCI-related mortality rates each year and future O/E mortality ratios was assessed. Multivariable linear regression was used to examine the association between index year O/E mortality and O/E mortality in subsequent years while adjusting for PCI volume and patient severity. Results This study included 67 New York hospitals and 960 hospital-years. Hospitals with low PCI-related mortality (O/E mortality ratio, ≤1) and high mortality (O/E mortality ratio, >1) had inverse associations between their O/E mortality ratio in the index year and the subsequent change in the ratio (hospitals with low mortality, r = -0.45; hospitals with high mortality, r = -0.60). Little of the variation in risk-adjusted mortality was explained by prior performance. An increase in the O/E mortality ratio from 1.0 to 2.0 in the index year was associated with a higher O/E mortality ratio of only 0.15 (95% CI, 0.02-0.27) in the following year. Conclusions and Relevance At hospitals with high or low PCI-related mortality rates, the rates largely regressed to the mean the following year. A hospital's risk-adjusted mortality rate was poorly associated with its future mortality. The annual hospital PCI-related mortality may not be a reliable factor associated with hospital quality to consider in a practice change or when helping patients select high-quality hospitals.
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Affiliation(s)
- Alexander T Sandhu
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Shun Kohsaka
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California.,Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Jay Bhattacharya
- Center for Health Policy, Department of Medicine, Stanford University, Stanford, California.,Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University, Stanford, California
| | - William F Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Robert A Harrington
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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23
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Kim SM, Cheung JW. Public reporting on cardiac electrophysiology procedures and outcomes: where are we now and where are we headed? J Interv Card Electrophysiol 2019; 56:137-141. [DOI: 10.1007/s10840-018-0400-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/20/2018] [Indexed: 11/27/2022]
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24
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Affiliation(s)
- Irfan A Dhalla
- Health Quality Ontario (Dhalla, Tepper); Department of Medicine (Dhalla) and Department of Family and Community Medicine (Tepper) and Institute of Health Policy, Management and Evaluation (Dhalla, Tepper), University of Toronto; St. Michael's Hospital (Dhalla, Tepper), Toronto, Ont.
| | - Joshua Tepper
- Health Quality Ontario (Dhalla, Tepper); Department of Medicine (Dhalla) and Department of Family and Community Medicine (Tepper) and Institute of Health Policy, Management and Evaluation (Dhalla, Tepper), University of Toronto; St. Michael's Hospital (Dhalla, Tepper), Toronto, Ont
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25
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Wadhera RK, Joynt Maddox KE, Yeh RW, Bhatt DL. Public Reporting of Percutaneous Coronary Intervention Outcomes: Moving Beyond the Status Quo. JAMA Cardiol 2019; 3:635-640. [PMID: 29800962 DOI: 10.1001/jamacardio.2018.0947] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance More than 20 years have passed since public reporting of percutaneous coronary intervention (PCI) outcomes first began in New York State, but reporting remains a polarizing issue. Observations Advocates of public reporting point to the strong incentive that public disclosure of outcomes data provides for institutions and clinicians to improve clinical care and to the importance of enabling patients to make informed choices about their care. Critics highlight the methodological challenges that impede fair and accurate assessments of care quality as well as reporting's unintended consequences. Public reporting of PCI outcomes has only been implemented in 5 states, but reporting efforts for multiple conditions and procedures are now proliferating nationally, propelled by the notion that transparency improves the quality of health care and fosters trust in health care institutions. Careful evaluation of the evidence to date for PCI in particular, however, suggests that enthusiasm for such efforts should be tempered. Conclusions and Relevance Public reporting has not achieved its primary objectives. Policy makers should consider variations of reporting that might strengthen care quality, empower patients, and mitigate undesirable repercussions.
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Affiliation(s)
- Rishi K Wadhera
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts.,Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical, Harvard Medical School, Boston, Massachusetts
| | - Karen E Joynt Maddox
- The Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Robert W Yeh
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical, Harvard Medical School, Boston, Massachusetts
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
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26
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Blumenthal DM, Valsdottir LR, Zhao Y, Shen C, Kirtane AJ, Pinto DS, Resnic FS, Maddox KEJ, Wasfy JH, Mehran R, Rosenfield K, Yeh RW. A Survey of Interventional Cardiologists' Attitudes and Beliefs About Public Reporting of Percutaneous Coronary Intervention. JAMA Cardiol 2019; 3:629-634. [PMID: 29801157 DOI: 10.1001/jamacardio.2018.1095] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Public reporting of procedural outcomes has been associated with lower rates of percutaneous coronary intervention (PCI) and worse outcomes after myocardial infarction. Contemporary data are limited on the influence of public reporting on interventional cardiologists' clinical decision making. Objective To survey a contemporary cohort of interventional cardiologists in Massachusetts and New York about how public reporting of PCI outcomes influences clinical decision making. Design, Setting, and Participants An online survey was developed with public reporting experts and administered electronically to eligible physicians in Massachusetts and New York who were identified by Doximity (an online physician networking site) and 2014 Medicare fee-for-service claims for PCI procedures. The personal and hospital characteristics of participants were ascertained via a comprehensive database from Doximity and the American Hospital Association annual surveys of US hospitals (2012 and 2013) and linked to survey responses. Associations between survey responses and characteristics of participants were evaluated in univariable and multivariable analyses. Main Outcomes and Measures Reported rate of avoidance of performing PCIs in high-risk patients and of perception of pressure from colleagues to avoid performing PCIs. Results Of the 456 physicians approached, 149 (32.7%) responded, including 67 of 129 (51.9%) in Massachusetts and 82 of 327 (25.1%) in New York. The mean (SD) age was 49 (9.2) years; 141 of 149 participants (94.6%) were men. Most participants reported practicing at medium to large, nonprofit hospitals with high-volume cardiac catheterization laboratories and cardiothoracic surgery capabilities. In 2014, participants had higher annual PCI volumes among Medicare patients than nonparticipants did (median, 31; interquartile range [IQR], 13-47 vs median, 17; IQR, 0-41; P < .001). Among participants, 65% reported avoiding PCIs on at least 2 occasions becase of concern that a bad outcome would negatively impact their publicly reported outcomes; 59% reported sometimes or often being pressured by colleagues to avoid performing PCIs because of a concern about the patient's risk of death. After multivariable adjustment, more years of experience practicing interventional cardiology was associated with lower odds of PCI avoidance. The state of practice was not associated with survey responses. Conclusions and Relevance Current PCI public reporting programs can foster risk-averse clinical practice patterns, which do not vary significantly between interventional cardiologists in New York and Massachusetts. Coordinated efforts by policy makers, health systems leadership, and the interventional cardiology community are needed to mitigate these unintended consequences.
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Affiliation(s)
- Daniel M Blumenthal
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Linda R Valsdottir
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Yuansong Zhao
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Cardiology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ajay J Kirtane
- Cardiology Division, Columbia University Medical Center, New York, New York.,Associate Editor
| | - Duane S Pinto
- Harvard Medical School, Boston, Massachusetts.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Cardiology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Fred S Resnic
- Cardiology Division, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Karen E Joynt Maddox
- Cardiovascular Division, Washington University School of Medicine, Saint Louis, Missouri
| | - Jason H Wasfy
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Roxana Mehran
- Cardiology Division, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ken Rosenfield
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Robert W Yeh
- Harvard Medical School, Boston, Massachusetts.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Cardiology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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27
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Balan P, Hsi B, Thangam M, Zhao Y, Monlezun D, Arain S, Charitakis K, Dhoble A, Johnson N, Anderson HV, Persse D, Warner M, Ostermayer D, Prater S, Wang H, Doshi P. The cardiac arrest survival score: A predictive algorithm for in-hospital mortality after out-of-hospital cardiac arrest. Resuscitation 2019; 144:46-53. [PMID: 31539610 DOI: 10.1016/j.resuscitation.2019.09.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 08/21/2019] [Accepted: 09/06/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is associated with high mortality. Current methods for predicting mortality post-arrest require data unavailable at the time of initial medical contact. We created and validated a risk prediction model for patients experiencing OHCA who achieved return of spontaneous circulation (ROSC) which relies only on objective information routinely obtained at first medical contact. METHODS We performed a retrospective evaluation of 14,892 OHCA patients in a large metropolitan cardiac arrest registry, of which 3952 patients had usable data. This population was divided into a derivation cohort (n = 2,635) and a verification cohort (n = 1,317) in a 2:1 ratio. Backward stepwise logistic regression was used to identify baseline factors independently associated with death after sustained ROSC in the derivation cohort. The cardiac arrest survival score (CASS) was created from the model and its association with in-hospital mortality was examined in both the derivation and verification cohorts. RESULTS Baseline characteristics of the derivation and verification cohorts were not different. The final CASS model included age >75 years (odds ratio [OR] = 1.61, confidence interval [CI][1.30-1.99], p < 0.001), unwitnessed arrest (OR = 1.95, CI[1.58-2.40], p < 0.001), home arrest (OR = 1.28, CI[1.07-1.53], p = 0.008), absence of bystander CPR (OR = 1.35, CI[1.12-1.64], p = 0.003), and non-shockable initial rhythm (OR = 3.81, CI[3.19-4.56], p < 0.001). The area under the curve for the model derivation and model verification cohorts were 0.7172 and 0.7081, respectively. CONCLUSION CASS accurately predicts mortality in OHCA patients. The model uses only binary, objective clinical data routinely obtained at first medical contact. Early risk stratification may allow identification of more patients in whom timely and aggressive invasive management may improve outcomes.
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Affiliation(s)
- Prakash Balan
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States.
| | - Brian Hsi
- Department of Internal Medicine, Division of Cardiology Houston Methodist Hospital, Weill Cornell Medical College, United States
| | - Manoj Thangam
- Department of Internal Medicine, Division of Cardiovascular Medicine Washington University School of Medicine St. Louis, United States
| | - Yelin Zhao
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Dominique Monlezun
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Salman Arain
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Konstantinos Charitakis
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Abhijeet Dhoble
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Nils Johnson
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - H Vernon Anderson
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - David Persse
- Physician Director of Emergency Medical Services City of Houston, United States
| | - Mark Warner
- Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Daniel Ostermayer
- Department of Emergency Medicine McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Samuel Prater
- Department of Emergency Medicine McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Henry Wang
- Department of Emergency Medicine McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Pratik Doshi
- Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine McGovern Medical School at The University of Texas Health Science Center Houston, United States; Department of Emergency Medicine McGovern Medical School at The University of Texas Health Science Center Houston, United States
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Jones DA, Rathod KS, Koganti S, Lim P, Firoozi S, Bogle R, Jain AK, MacCarthy PA, Dalby MC, Malik IS, Mathur A, DeSilva R, Rakhit R, Kalra SS, Redwood S, Ludman P, Wragg A. The association between the public reporting of individual operator outcomes with patient profiles, procedural management, and mortality after percutaneous coronary intervention: an observational study from the Pan-London PCI (BCIS) Registry using an interrupted time series analysis. Eur Heart J 2019; 40:2620-2629. [PMID: 31220238 DOI: 10.1093/eurheartj/ehz152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/17/2019] [Accepted: 03/03/2019] [Indexed: 01/10/2023] Open
Abstract
AIMS The public reporting of healthcare outcomes has a number of potential benefits; however, unintended consequences may limit its effectiveness as a quality improvement process. We aimed to assess whether the introduction of individual operator specific outcome reporting after percutaneous coronary intervention (PCI) in the UK was associated with a change in patient risk factor profiles, procedural management, or 30-day mortality outcomes in a large cohort of consecutive patients. METHODS AND RESULTS This was an observational cohort study of 123 780 consecutive PCI procedures from the Pan-London (UK) PCI registry, from January 2005 to December 2015. Outcomes were compared pre- (2005-11) and post- (2011-15) public reporting including the use of an interrupted time series analysis. Patients treated after public reporting was introduced were older and had more complex medical problems. Despite this, reported in-hospital major adverse cardiovascular and cerebrovascular events rates were significantly lower after the introduction of public reporting (2.3 vs. 2.7%, P < 0.0001). Interrupted time series analysis demonstrated evidence of a reduction in 30-day mortality rates after the introduction of public reporting, which was over and above the existing trend in mortality before the introduction of public outcome reporting (35% decrease relative risk 0.64, 95% confidence interval 0.55-0.77; P < 0.0001). CONCLUSION The introduction of public reporting has been associated with an improvement in outcomes after PCI in this data set, without evidence of risk-averse behaviour. However, the lower reported complication rates might suggest a change in operator behaviour and decision-making confirming the need for continued surveillance of the impact of public reporting on outcomes and operator behaviour.
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Affiliation(s)
- Daniel A Jones
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | - Krishnaraj S Rathod
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | - Sudheer Koganti
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | - Pitt Lim
- Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, Blackshaw Road, Tooting, London, UK
| | - Sam Firoozi
- Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, Blackshaw Road, Tooting, London, UK
| | - Richard Bogle
- Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, Blackshaw Road, Tooting, London, UK
| | - Ajay K Jain
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | - Philip A MacCarthy
- Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, Denmark Hill, 10 Cutcombe Road, London, UK
| | - Miles C Dalby
- Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Middlesex, UK
| | - Iqbal S Malik
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, Du Cane Road, London, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | - Ranil DeSilva
- Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Middlesex, UK
| | - Roby Rakhit
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, UK
| | - Sundeep Singh Kalra
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, UK
| | - Simon Redwood
- Department of Cardiology, St Thomas' NHS Foundation Trust, Guys & St. Thomas Hospital, Westminster Bridge Rd, London, UK
| | - Peter Ludman
- Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - Andrew Wragg
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
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Bernier ML, Romer LH, Bembea MM. Spectrum of Current Management of Pediatric Pulmonary Hypertensive Crisis. Crit Care Explor 2019; 1:e0037. [PMID: 32166278 PMCID: PMC7063944 DOI: 10.1097/cce.0000000000000037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Pulmonary hypertension is a growing pediatric problem and children may present with pulmonary hypertensive crisis-a life-threatening emergency requiring acute interventions. The aim of this study was to characterize the broad spectrum of care provided in North American PICUs for children who present with pulmonary hypertensive crisis. DESIGN Electronic cross-sectional survey. Survey questions covered the following: demographics of the respondents, institution, and patient population; pulmonary hypertension diagnostic modalities; pulmonary hypertension-specific pharmacotherapies; supportive therapies, including sedation, ventilation, and inotropic support; and components of multidisciplinary teams. SETTING PICUs in the United States and Canada. SUBJECTS Faculty members from surveyed institutions. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS The response rate was 50% of 99 identified institutions. Of the respondents, 82.2% were pediatric intensivists from large units, and 73.9% had over a decade of experience beyond training. Respondents provided care for a median of 10 patients/yr with acute pulmonary hypertensive crisis. Formal echocardiography protocols existed at 61.1% of institutions with varying components reported. There were no consistent indications for cardiac catheterization during a pulmonary hypertensive crisis admission. All institutions used inhaled nitric oxide, and enteral phosphodiesterase type 5 inhibitor was the most frequently used additional targeted vasodilator therapy. Milrinone and epinephrine were the most frequently used vasoactive infusions. Results showed no preferred approach to mechanical ventilation. Fentanyl and dexmedetomidine were the preferred sedative infusions. A formal pulmonary hypertension consulting team was reported at 51.1% of institutions, and the three most common personnel were pediatric cardiologist, pediatric pulmonologist, and advanced practice nurse. CONCLUSIONS The management of critically ill children with acute pulmonary hypertensive crisis is diverse. Findings from this survey may inform formal recommendations - particularly with regard to care team composition and pulmonary vasodilator therapies - as North American guidelines are currently lacking. Additional work is needed to determine best practice, standardization of practice, and resulting impact on outcomes.
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Affiliation(s)
- Meghan L Bernier
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Melania M Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Qi AC, Butler AM, Joynt Maddox KE. The Role Of Social Risk Factors In Dialysis Facility Ratings And Penalties Under A Medicare Quality Incentive Program. Health Aff (Millwood) 2019; 38:1101-1109. [DOI: 10.1377/hlthaff.2018.05406] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Andrew C. Qi
- Andrew C. Qi is a medical student at the Washington University School of Medicine, in Saint Louis, Missouri
| | - Anne M. Butler
- Anne M. Butler is an instructor of medicine at the Washington University School of Medicine, in Saint Louis
| | - Karen E. Joynt Maddox
- Karen E. Joynt Maddox is an assistant professor of medicine (cardiology) at the Washington University School of Medicine, in Saint Louis
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The Impact of Public Performance Reporting on Market Share, Mortality, and Patient Mix Outcomes Associated With Coronary Artery Bypass Grafts and Percutaneous Coronary Interventions (2000-2016): A Systematic Review and Meta-Analysis. Med Care 2019; 56:956-966. [PMID: 30234769 PMCID: PMC6226216 DOI: 10.1097/mlr.0000000000000990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Supplemental Digital Content is available in the text. Objective: Public performance reporting (PPR) of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) outcomes aim to improve the quality of care in hospitals, surgeons and to inform consumer choice. Past CABG and PCI studies have showed mixed effects of PPR on quality and selection. The aim of this study was to undertake a systematic review and meta-analysis of the impact of PPR on market share, mortality, and patient mix outcomes associated with CABG and PCI. Methods: Six online databases and 8 previous reviews were searched for the period 2000–2016. Data extraction, quality assessment, systematic critical synthesis, and meta-analysis (where possible) were carried out on included studies. Results: In total, 22 relevant articles covering mortality (n=19), patient mix (n=14), and market share (n=6) outcomes were identified. Meta-analyses showed that PPR led to a near but not significant reduction in short-term mortality for both CABG and PCI. PPR on CABG showed a positive effect on market share for hospitals (3 of 6 studies) and low-performing surgeons (2 of 2 studies). Five of 6 PCI studies found that high-risk patients were less likely to be treated in States with PPR. Conclusions: There is some evidence that PPR reduces mortality rates in CABG/PCI-treated patients. The significance of there being no strong evidence, in the period 2000–2016, should be considered. There is need for both further development of PPR practice and further research into the intended and unintended consequences of PPR.
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Jenkins PC, Painter S, Bell TM, Kline JA, Zarzaur BL. The conference effect: National surgery meetings are associated with increased mortality at trauma centers without American College of Surgeons verification. PLoS One 2019; 14:e0214020. [PMID: 30913224 PMCID: PMC6435237 DOI: 10.1371/journal.pone.0214020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/05/2019] [Indexed: 01/16/2023] Open
Abstract
Background Thousands of physicians attend scientific conferences each year. While recent data indicate that variation in staffing during such meetings impacts survival of non-surgical patients, the association between treatment during conferences and outcomes of a surgical population remain unknown. The purpose of this study was to examine mortality resulting from traumatic injuries and the influence of hospital admission during national surgery meetings. Study design Retrospective analysis of in-hospital mortality using data from the Trauma Quality Improvement Program (2010–2011). Identified patients admitted during four annual meetings and compared their mortality with that of patients admitted during non-conference periods. Analysis included 155 hospitals with 12,256 patients admitted on 42 conference days and 82,399 patients admitted on 270 non-conference days. Multivariate analysis performed separately for hospitals with different levels of trauma center verification by state and American College of Surgeons (ACS) criteria. Results Patient characteristics were similar between meeting and non-meeting dates. At ACS level I and level II trauma centers during conference versus non-conference dates, adjusted mortality was not significantly different. However, adjusted mortality increased significantly for patients admitted to trauma centers that lacked ACS trauma verification during conferences versus non-conference days (OR 1.2, p = 0.008), particularly for patients with penetrating injuries, whose mortality rose from 11.6% to 15.9% (p = 0.006). Conclusions Trauma mortality increased during surgery conferences compared to non-conference dates for patients admitted to hospitals that lacked ACS trauma level verification. The mortality difference at those hospitals was greatest for patients who presented with penetrating injuries.
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Affiliation(s)
- Peter C Jenkins
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Scott Painter
- Department of Surgery, University of Illinois College of Medicine in Peoria, Peoria, Illinois, United States of America
| | - Teresa M Bell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Jeffrey A Kline
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Ben L Zarzaur
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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Wadhera RK, O'Brien CW, Joynt Maddox KE, Ho KKL, Pinto DS, Resnic FS, Shah PB, Yeh RW. Public Reporting of Percutaneous Coronary Intervention Outcomes: Institutional Costs and Physician Burden. J Am Coll Cardiol 2019; 73:2604-2608. [PMID: 30885686 DOI: 10.1016/j.jacc.2019.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Colin W O'Brien
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Karen E Joynt Maddox
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Kalon K L Ho
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Duane S Pinto
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Frederic S Resnic
- Division of Cardiovascular Medicine, Lahey Hospital and Medical Center and Tufts University School of Medicine, Burlington, Massachusetts
| | - Pinak B Shah
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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Xia L, Talwar R, Taylor BL, Shin MH, Berger IB, Sperling CD, Chelluri RR, Zambrano IA, Raman JD, Guzzo TJ. National trends and disparities of minimally invasive surgery for localized renal cancer, 2010 to 2015. Urol Oncol 2019; 37:182.e17-182.e27. [DOI: 10.1016/j.urolonc.2018.10.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/11/2018] [Accepted: 10/31/2018] [Indexed: 01/06/2023]
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Ellis SG. How Should We Treat Patients With Silent Myocardial Ischemia?: Learning From Relevant Evidence. JACC Cardiovasc Interv 2019; 12:242-244. [PMID: 30660460 DOI: 10.1016/j.jcin.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/04/2018] [Indexed: 11/26/2022]
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Chancellor WZ, Mehaffey JH, Beller JP, Krebs ED, Hawkins RB, Yount K, Fonner CE, Speir AM, Quader MA, Rich JB, Yarboro LT, Teman NR, Ailawadi G. Current quality reporting methods are not adequate for salvage cardiac operations. J Thorac Cardiovasc Surg 2019; 159:194-200.e1. [PMID: 30826101 PMCID: PMC6660423 DOI: 10.1016/j.jtcvs.2019.01.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/19/2018] [Accepted: 01/15/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Outcomes in cardiac surgery are benchmarked against national Society of Thoracic Surgeons (STS) data and include patients undergoing elective, urgent, emergent, and salvage operations. This practice relies on accurate risk adjustment to avoid risk-averse behavior. We hypothesize that the STS risk calculator does not adequately characterize the risk of salvage operations because of their heterogeneity and infrequent occurrence. METHODS Data on all cardiac surgery patients with an STS predicted risk score (2002-2017) were extracted from a regional database of 19 cardiac surgery centers. Patients were stratified according to operative status for univariate analysis. Observed-to-expected (O:E) ratios for mortality and composite morbidity/mortality were calculated and compared among elective, urgent, emergent, and salvage patients. RESULTS A total of 76,498 patients met inclusion criteria. The O:E mortality ratios for elective, urgent, and emergent cases were 0.96, 0.98, and 0.93, respectively (all P values > .05). However, mortality rate was significantly higher than expected for salvage patients (O:E ratio, 1.41; P = .04). Composite morbidity/mortality rate was lower than expected in elective (O:E ratio, 0.81; P = .0001) and urgent (O:E ratio, 0.93; P = .0001) cases but higher for emergent (O:E ratio, 1.13; P = .0006) and salvage (O:E ratio, 1.24; P = .01). O:E ratios for salvage mortality were highly variable among each of the 19 centers. CONCLUSIONS The current STS risk models do not adequately predict outcomes for salvage cardiac surgery patients. On the basis of these results, we recommend more detailed reporting of salvage outcomes to avoid risk aversion in these potentially life-saving operations.
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Affiliation(s)
- William Z Chancellor
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
| | - J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va; Center for Health Policy, University of Virginia, Charlottesville, Va
| | - Jared P Beller
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
| | - Elizabeth D Krebs
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
| | - Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va; Center for Health Policy, University of Virginia, Charlottesville, Va
| | - Kenan Yount
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
| | | | - Alan M Speir
- INOVA Heart and Vascular Institute, Falls Church, Va
| | - Mohammed A Quader
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Va
| | - Jeffrey B Rich
- Virginia Cardiac Services Quality Initiative, Virginia Beach, Va
| | - Leora T Yarboro
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
| | - Nicholas R Teman
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va.
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Shahian DM, Torchiana DF, Engelman DT, Sundt TM, D'Agostino RS, Lovett AF, Cioffi MJ, Rawn JD, Birjiniuk V, Habib RH, Normand SLT. Mandatory public reporting of cardiac surgery outcomes: The 2003 to 2014 Massachusetts experience. J Thorac Cardiovasc Surg 2018; 158:110-124.e9. [PMID: 30772041 DOI: 10.1016/j.jtcvs.2018.12.072] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Beginning in 2002, all 14 Massachusetts nonfederal cardiac surgery programs submitted Society of Thoracic Surgeons (STS) National Database data to the Massachusetts Data Analysis Center for mandatory state-based analysis and reporting, and to STS for nationally benchmarked analyses. We sought to determine whether longitudinal prevalences and trends in risk factors and observed and expected mortality differed between Massachusetts and the nation. METHODS We analyzed 2003 to 2014 expected (STS predicted risk of operative [in-hospital + 30-day] mortality), observed, and risk-standardized isolated coronary artery bypass graft mortality using Massachusetts STS data (N = 39,400 cases) and national STS data (N = 1,815,234 cases). Analyses included percentage shares of total Massachusetts coronary artery bypass graft volume and expected mortality rates of 2 hospitals before and after outlier designation. RESULTS Massachusetts patients had significantly higher odds of diabetes, peripheral vascular disease, low ejection fraction, and age ≥75 years relative to national data and lower odds of shock (odds ratio, 0.66; 99% confidence interval, 0.53-0.83), emergency (odds ratio, 0.57, 99% confidence interval, 0.52-0.61), reoperation, chronic lung disease, dialysis, obesity, and female sex. STS predicted risk of operative [in-hospital + 30-day] mortality for Massachusetts patients was higher than national rates during 2003 to 2007 (P < .001) and no different during 2008 to 2014 (P = .135). Adjusting for STS predicted risk of operative [in-hospital + 30-day] mortality, Massachusetts patients had significantly lower odds (odds ratio, 0.79; 99% confidence interval, 0.66-0.96) of 30-day mortality relative to national data. Outlier programs experienced inconsistent, transient influences on expected mortality and their percentage shares of Massachusetts coronary artery bypass graft cases. CONCLUSIONS During 12 years of mandatory public reporting, Massachusetts risk-standardized coronary artery bypass graft mortality was consistently and significantly lower than national rates, expected rates were comparable or higher, and evidence for risk aversion was conflicting and inconclusive.
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Affiliation(s)
- David M Shahian
- Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - David F Torchiana
- Harvard Medical School, Boston, Mass; Partners HealthCare, Boston, Mass
| | - Daniel T Engelman
- Division of Cardiac Surgery, Baystate Medical Center, University of Massachusetts-Baystate, Springfield, Mass
| | - Thoralf M Sundt
- Harvard Medical School, Boston, Mass; Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Richard S D'Agostino
- Department of Thoracic and Cardiovascular Surgery, Lahey Health System, Burlington, Mass
| | - Ann F Lovett
- Harvard Medical School, Boston, Mass; Department of Health Care Policy, Harvard Medical School, Boston, Mass
| | - Matthew J Cioffi
- Harvard Medical School, Boston, Mass; Department of Health Care Policy, Harvard Medical School, Boston, Mass
| | - James D Rawn
- Harvard Medical School, Boston, Mass; Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | | | - Robert H Habib
- The Society of Thoracic Surgeons Research Center, Boston, Mass
| | - Sharon-Lise T Normand
- Department of Health Care Policy, Harvard Medical School, Boston, Mass; T.H. Chan School of Public Health, Harvard University, Boston, Mass
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Affiliation(s)
- Karen E Joynt
- From Brigham and Women's Hospital, Boston, MA; and Harvard T.H. Chan School of Public Health, Boston, MA.
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39
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Rymer JA, Califf RM. The evolution of PCI registries: implementing a sustainable future for health systems and clinicians. EUROINTERVENTION 2018; 14:1076-1079. [PMID: 30451692 DOI: 10.4244/eijv14i10a193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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40
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Dowdy SC, Cliby WA, Famuyide AO. Quality indicators in gynecologic oncology. Gynecol Oncol 2018; 151:366-373. [DOI: 10.1016/j.ygyno.2018.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/25/2018] [Accepted: 09/01/2018] [Indexed: 10/28/2022]
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Wadhera RK, Yeh RW. Inadequate Surrogates for Imperfect Quality Measures. Circ Cardiovasc Interv 2018; 11:e007216. [PMID: 30354606 DOI: 10.1161/circinterventions.118.007216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rishi K Wadhera
- Brigham and Women's Hospital Heart and Vascular Center (R.K.W.), Harvard Medical School, Boston, MA.,Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center (R.K.W., R.W.Y.), Harvard Medical School, Boston, MA
| | - Robert W Yeh
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center (R.K.W., R.W.Y.), Harvard Medical School, Boston, MA
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Surgical Quality Improvement: Working Toward Value or a Work in Progress? J Surg Res 2018; 235:160-166. [PMID: 30691790 DOI: 10.1016/j.jss.2018.09.086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/10/2018] [Accepted: 09/28/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite numerous national programs intended to ensure patients receive high-quality surgical care, contemporaneous quality improvement initiatives (QIIs) are limited by the challenges associated with developing universal consensus about how best to define "quality" and the identification of appropriate and actionable quality measures. MATERIALS AND METHODS Using the Donabedian conceptual model for the evaluation of health care quality, representative examples of existing surgical QIIs at each level of health care (i.e., structure, process, and outcome) were identified, and the effectiveness of these programs was discussed. RESULTS Surgical volume-based measures are a common structural quality indicator. It remains unclear whether volume-based QIIs, such as "Take the Volume Pledge" and the Leapfrog Group's Evidence-Based Hospital Referral initiative, would improve surgical outcomes or potentially exacerbate existing health care disparities. QIIs focused on processes of care, such as the Surgical Care Improvement Project, are frequently effective at improving measure compliance without clearly improving care quality. Risk-adjusted outcome measures remain common quality indicators. But, relevant procedure-specific outcomes are lacking, and continuing to rely on perioperative morbidity and mortality may not provide the most robust picture of surgical quality. CONCLUSIONS Data regarding the effectiveness of existing QIIs suggest there may be important opportunities to either select measures that more accurately reflect quality surgical care or enhance the manner in which current quality indicators are measured and reported to better capture the complex dynamics of surgical services at the point of care.
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Affiliation(s)
| | - Kirk N Garratt
- From Christiana Care Health System, Newark, DE (W.S.W., K.N.G.)
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44
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Li M, Liu H. Implementation of a clinical nursing pathway for percutaneous coronary intervention: A prospective study. Geriatr Nurs 2018; 39:593-596. [DOI: 10.1016/j.gerinurse.2018.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/16/2018] [Indexed: 02/08/2023]
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Can Urban-Rural Patterns of Hospital Selection Be Changed Using a Report Card Program? A Nationwide Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091827. [PMID: 30149514 PMCID: PMC6164887 DOI: 10.3390/ijerph15091827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/13/2018] [Accepted: 08/22/2018] [Indexed: 11/24/2022]
Abstract
Background: Guiding patients to choose high-quality healthcare providers helps ensure that patients receive excellent care and helps reduce health disparities among patients of different socioeconomic backgrounds. The purpose of this study was to examine and compare the effect of implementing a report-card program on the patterns of hospital selection in patients from different socioeconomic subgroups. Patients undergoing total knee replacement (TKR) surgery were used as the sample population. Methods: A patient-level, retrospective, observational and cross-sectional study design was conducted. Taiwan National Health Insurance claims data were used and all patients in this database who had received TKR between April 2007–March 2008 (prior to report-card program implementation) and between April 2009–March 2010 (after program implementation) were included. Those patients who were under 18 years of age or who lacked area-of-residence or National Health Insurance premium information were excluded. Travelling distance to the hospital and level of hospital performance were used to evaluate the effect of the report-card program. Results: A total of 32,821 patients were included in this study. The results showed that patterns of hospital selection varied based on the socioeconomic characteristics of patients. In terms of travelling distance and hospital selection, the performance of urban and higher income patients was shorter and better, respectively, than their rural and lower-income peers both before and after report-card-program implementation. Moreover, although the results of multivariate analysis showed that the urban-rural difference in travelling distance enlarged (by 4.75 km) after implementation of the report-card program, this increase was shown to not be significantly related to this program. Furthermore, the results revealed that implementation of the report-card program did not significantly affect the urban-rural difference in terms of level of hospital performance. Conclusions: A successful report-card program should ensure that patients in all socioeconomic groups obtain comprehensive information. However, the results of this study indicate that those in higher socioeconomic subgroups attained more benefits from the program than their lower-subgroup peers. Ensuring that all have equal opportunity to access high-quality healthcare providers may therefore be the next issue that needs to be addressed and resolved.
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Wang DE, Wadhera RK, Bhatt DL. Public reporting of percutaneous coronary interventions. Med J Aust 2018; 209:104-105. [PMID: 30071811 DOI: 10.5694/mja18.00569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/14/2018] [Indexed: 11/17/2022]
Affiliation(s)
| | - Rishi K Wadhera
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Mass, USA
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Affiliation(s)
- Karen E. Joynt Maddox
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
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Yamana H, Kodan M, Ono S, Morita K, Matsui H, Fushimi K, Imamura T, Yasunaga H. Hospital quality reporting and improvement in quality of care for patients with acute myocardial infarction. BMC Health Serv Res 2018; 18:523. [PMID: 29973281 PMCID: PMC6033287 DOI: 10.1186/s12913-018-3330-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Although public reporting of hospital performance is becoming common, it remains uncertain whether public reporting leads to improvement in clinical outcomes. This study was conducted to evaluate whether enrollment in a quality reporting project is associated with improvement in quality of care for patients with acute myocardial infarction. Methods We conducted a quasi-experimental study using hospital census survey and national inpatient database in Japan. Hospitals enrolled in a ministry-led quality reporting project were matched with non-reporting control hospitals by one-to-one propensity score matching using hospital characteristics. Using the inpatient data of acute myocardial infarction patients hospitalized in the matched hospitals during 2011–2013, difference-in-differences analyses were conducted to evaluate the changes in unadjusted and risk-adjusted in-hospital mortality rates over time that are attributable to intervention. Results Matching between hospitals created a cohort of 30,220 patients with characteristics similar between the 135 reporting and 135 non-reporting hospitals. Overall in-hospital mortality rates were 13.2% in both the reporting and non-reporting hospitals. There was no significant association between hospital enrollment in the quality reporting project and change over time in unadjusted mortality (OR, 0.98; 95% CI, 0.80–1.22). In 28,168 patients eligible for evaluation of risk-adjusted mortality, enrollment was also not associated with change in risk-adjusted mortality (OR, 0.98; 95% CI, 0.81–1.17). Conclusions Enrollment in the quality reporting project was not associated with short-term improvement in quality of care for patients with acute myocardial infarction. Additional efforts may be necessary to improve quality of care. Electronic supplementary material The online version of this article (10.1186/s12913-018-3330-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, 2-5-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan.
| | - Mariko Kodan
- Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, 2-5-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan.,Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Sachiko Ono
- Department of Biostatistics & Bioinformatics, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kiyohide Fushimi
- Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, 2-5-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan.,Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-0813, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Harhash A, Rao P, Kern KB. The Role of Cardiac Catheterization after Cardiac Arrest. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2018. [DOI: 10.15212/cvia.2017.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Williams MP, Modgil V, Drake MJ, Keeley F. The effect of consultant outcome publication on surgeon behaviour: a systematic review and narrative synthesis. Ann R Coll Surg Engl 2018; 100:428-435. [PMID: 29962298 PMCID: PMC6111901 DOI: 10.1308/rcsann.2018.0052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 02/02/2023] Open
Abstract
Introduction Surgeon-specific outcome data, or consultant outcome publication, refers to public access to named surgeon procedural outcomes. Consultant outcome publication originates from cardiothoracic surgery, having been introduced to US and UK surgery in 1991 and 2005, respectively. It has been associated with an improvement in patient outcomes. However, there is concern that it may also have led to changes in surgeon behaviour. This review assesses the literature for evidence of risk-averse behaviour, upgrading of patient risk factors and cessation of low-volume or poorly performing surgeons. Materials and methods A systematic literature review of Embase and Medline databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Original studies including data on consultant outcome publication and its potential effect on surgeon behaviour were included. Results Twenty-five studies were identified from the literature search. Studies suggesting the presence of risk-averse behaviour and upgrading of risk factors tended to be survey based, with studies contrary to these findings using recognised regional and national databases. Discussion and conclusion Our review includes instances of consultant outcome publication leading to risk-averse behaviour, upgrading of risk factors and cessation of low-volume or poorly performing surgeons. As UK data on consultant outcome publication matures, further research is essential to ensure that high-risk patients are not inappropriately turned down for surgery.
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Affiliation(s)
- MP Williams
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - V Modgil
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - MJ Drake
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - F Keeley
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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