Abstract 20271: A Comprehensive Evaluation of Hospital-Level Appropriateness, Episode Costs and Outcomes for Assessing Value in Percutaneous Coronary Intervention: A Statewide Analysis
Introduction: Appropriate patient selection, good outcomes, and low episode costs are important dimensions of high value care in percutaneous coronary intervention (PCI). Understanding the interrelationships between these dimensions is important for quality improvement and informing overall value in PCI.
Methods: This retrospective cohort study included all fee for service Medicare patients undergoing PCI for a non-acute myocardial infarction (AMI) indication in the State of Michigan from 1/1/2010 to 12/31/2014. Administrative claims were used to identify PCI episodes and mapped to the Blue Cross Blue Shield of Michigan Cardiovascular Collaborative (BMC2). Clinical data from the BMC2 were used to calculate institutional appropriate use criteria (AUC) and in hospital outcomes. Claims were used to assess readmissions, 90-day standardized episode costs, and longitudinal mortality.
Results: A total of 18,413 non-AMI PCI’s were performed at 33 sites performing at least 100 procedures during the study period for a variety of indications (76.4% unstable angina, 15.9% stable angina, and 7.7% other) with mean hospital AUC of 8.0 (+/- sd 1.7), episode costs of $23,951 (+/- sd $15,379), 30-day readmissions of 12.2%, and mortality rates of 0.3% (in-hospital), 0.5% (30-day), and 1.5% (90-day). Hospital level AUC were not correlated with episode costs or readmission or mortality outcomes. Institutions with high episode costs had more readmissions as well as higher longitudinal mortality (figure). High institutional readmissions were correlated with higher institutional mortality for all three mortality measures (in-hospital: rho = 0.46, p = 0.007, 30 day: rho = .37, p = 0.033, 90 day: rho = .35, p = 0.046).
Conclusion: Institutional AUC in PCI are high and are not correlated with episode costs or outcomes. High institutional episode costs are in part driven by poor outcomes. These findings have implications for assessing overall value in PCI.
- Quality improvement
- Percutaneous coronary intervention (PCI)
- Coronary interventions
- Coronary heart disease
- Health economics
Author Disclosures: D. Alyesh: None. M. Seth: None. D. Miller: None. J. Dupree: None. J. Syrjamaki: None. S. Dixon: None. H. Gurm: None. B. Nallamothu: None.
- © 2016 by American Heart Association, Inc.