Abstract 20081: The Influence of Public Reporting of Outcome Data on Decision Making by Interventional Cardiologists: A Follow-Up Survey
Introduction: The objective is to determine if public reporting of interventional cardiologist (IC) specific percutaneous coronary intervention (PCI) mortality data in New York State (NYS) continues to significantly influence IC decisions to perform PCI in high risk patients. A survey in 2005 found that ICs were less likely to perform PCI in high risk patients due to public reporting. In 2008 NYS excluded patients with refractory shock (Systolic Blood Pressure (SBP) <80mmHg or Cardiac Index (CI) <2L/min/ m2 despite support) from public reporting and in 2010 excluded patients with anoxic brain injury (ABI).
Hypothesis: Public reporting of IC specific mortality data still influences IC decision making on whether to perform PCI.
Methods: To assess the potential continued influence from public reporting of IC specific mortality data in NYS, we administered a voluntary survey to all NYS IC in the most recent report (2009-2011) at the time of the survey.
Results: 159 IC out of 320 (50%) responded. The majority disagree or strongly disagree that mortality statistics are an accurate measure of individual IC quality (90%), provide useful information to the public (78%), improve patient care (75%) or should determine reimbursement (85%). These results are unchanged from 2005. The majority agree or strongly agree that the exclusion of refractory shock and ABI has made them more likely to perform PCI on these patients (75% and 81% respectively). However, most agree or strongly agree (72%) that the continued inclusion of cardiogenic but not refractory shock (SBP <90mmHg CI < 2.2L/min/m2) still makes them less likely to perform PCI in this high risk group. Most agree or strongly agree (92%) with the concept of a physician panel to review deaths and exclude from public reporting those deaths not deemed to be procedure related. The majority (87%) reported that no patient in the last 2 years has asked about their outcome data.
Conclusions: In NYS, exclusion of certain high risk patient groups from public reporting of IC specific outcome data has made IC more likely to perform PCI in these patients compared to prior to their exclusion. Continued inclusion of other high risk patients in public reporting of IC specific outcome data continues to make IC less likely to perform PCI in these patients.
- Performance measurement
- Percutaneous coronary intervention (PCI)
- Quality assessment
- Follow-up studies
- Shock, cardiogenic
Author Disclosures: G. Fernandez: None. C.R. Narins: None. F.S. Ling: None.
- © 2016 by American Heart Association, Inc.