Abstract 17436: Reporting Trends and Outcomes in ST-elevation Myocardial Infarction National Hospital Quality Assessment Programs
Background: For patients who undergo primary PCI (pPCI) for ST-segment Elevation Myocardial Infarction (STEMI), the door-to-balloon time is an important performance measure reported to the Centers for Medicare & Medicaid Services (CMS) and tied to hospital quality assessment and reimbursement. The use and impact of broad exclusion criteria associated with this measure are unclear.
Methods: All pPCI-eligible patients at 3 Massachusetts Hospitals (Brigham and Women’s, Massachusetts General, North Shore Medical Center) were evaluated for CMS reporting status. Rates of CMS reporting exclusion were the primary endpoints of interest. Key secondary endpoints were between-group differences in patient characteristics, door-to-balloon times, and 1-year mortality rates.
Results: From 2005 to 2011, twenty six percent (408) of the 1,548 pPCI cases were excluded from CMS reporting. This percentage increased over the study period from 13.9% in 2005 to 36.7% in the first 3 quarters of 2011 (p<0.001). The most frequent cause of exclusion was for a diagnostic dilemma, accounting for 31.2% of excluded patients. The one-year mortality for CMS-excluded patients was double that of CMS-included patients (13.5% vs. 6.6%, p < 0.001) (Figure) despite only a modest difference in median door-to-balloon times (82 minutes [IQR 60, 115] vs. 67 minutes [IQR 50, 85] for CMS-excluded and -reported patients respectively).
Discussion: Over a quarter of patients who underwent pPCI were excluded from hospital quality reports collected by CMS and this percentage has grown substantially over time. These findings may have significant implications for our understanding of process improvement in pPCI and mechanisms for reimbursement through Medicare.
- © 2013 by American Heart Association, Inc.