Response to Outlier Status
Lessons From Public Reporting for Percutaneous Coronary Intervention
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- health care quality, access, and evaluation
- hospital mortality
- percutaneous coronary intervention
Article, see p 1897
Public reporting of outcomes for percutaneous coronary intervention (PCI) has been taking place since New York initiated such a program in the 1990s. Pennsylvania followed suit in 2000, and Massachusetts shortly thereafter.1 Over this time, public reporting has been the subject of a great deal of controversy, with supporters arguing that public reporting drives critical improvements in care, and detractors arguing that it drives risk aversion and the denial of procedures to patients who may stand to benefit from receiving PCI.2
In this issue of Circulation, Waldo et al3 put one specific element of public reporting under a microscope, with somewhat surprising results. The authors examine what happened to hospitals that were found to be outliers in mortality rates as part of the public reporting programs in Massachusetts and New York. This was a not-uncommon phenomenon, with 31 hospitals (36%) identified as outliers over the study period.
Contrary to expectations, Waldo et al report that hospitals that were identified as negative outliers during the study period did not limit the PCIs they subsequently performed, demonstrating similar growth in PCI rates as nonoutlier hospitals. In addition, and perhaps even more important, hospitals identified as outliers demonstrated a significant reduction in mortality rates following identification as outliers, a benefit that was concentrated in patients receiving PCI. Taken together, these findings suggest that being identified as an outlier was associated with improvements in care quality.
To be clear, the present study does not answer the question of whether public reporting is associated with better outcomes than not having public reporting, nor whether …