Abstract 15497: Role of Hospital Performance on PCI Measures in Explaining Hospital Variation in 30-Day Risk-Standardized Mortality Rates
Introduction: There is much interest in measuring and reporting the quality of care delivered by PCI hospitals. Both process and outcome measures represent potentially important indicators of hospital quality, but the extent to which hospital performance on process metrics correlates with variations in hospital PCI mortality is unknown. We examined the explained variance between hospitals’ performance on PCI process metrics and 30-day risk-standardized mortality rates (RSMR).
Methods: We linked the NCDR CathPCI Registry with Medicare claims data for procedures performed from 2010-2011. We assessed hospital performance on PCI-related process measures (aspirin, thienopyridines, and statins on discharge; door-to-balloon time under ninety minutes; referral to cardiac rehabilitation; and a composite of all process metrics), and calculated hospitals’ RSMR using hierarchical linear modeling. Variance analyses were used to calculate the association between hospital performance on process metrics and 30-day RSMRs. Given the heterogeneity in PCI mortality by indication, rates were calculated separately in patients with a) STEMI or cardiogenic shock or b) neither STEMI nor cardiogenic shock.
Results: The median 30-day RSMR was 12.1 for STEMI/Shock patients (interquartile range: 10.9-13.4) and 1.7 for No STEMI/No Shock patients (interquartile range: 1.6-2.0). Relatively little variation was seen in the discharge medication process metrics. Hospital performance on process measures only modestly explained the observed variation in 30-day RSMRs (Table). Individual process metrics explained between 0.5% and 2.3% of the variation in 30-day RSMR for STEMI/Shock patients and between 0.1% and 5.8% of the variation in No STEMI/No Shock patients.
Conclusion: Hospital-level performance on PCI process measures explains only a small proportion of variations in RSMRs. Our findings suggest that PCI process and outcome measures represent distinct domains of quality.
- Percutaneous coronary intervention (PCI)
- Interventional cardiology
- Quality of medical care
- Quality assessment
Author Disclosures: P.W. Chui: None. C. Parzynski: None. F.A. Masoudi: None. J.C. Messenger: None. L.E. Slattery: None. J.P. Curtis: None.
This research has received full or partial funding support from the American Heart Association
- © 2014 by American Heart Association, Inc.