Hospital Performance on Percutaneous Coronary Intervention Process and Outcomes Measures

J Am Heart Assoc. 2017 Apr 26;6(5):e004276. doi: 10.1161/JAHA.116.004276.

Abstract

Background: The Physician Consortium for Performance Improvement recently proposed percutaneous coronary intervention (PCI)-specific process measures. However, information about hospital performance on these measures and the association of PCI process and outcomes measures are not available.

Methods and results: We linked the National Cardiovascular Data Registry (NCDR) CathPCI Registry with Medicare claims data to assess hospital performance on established PCI process measures (aspirin, thienopyridines, and statins on discharge; door-to-balloon time; and referral to cardiac rehabilitation), newly proposed PCI process measures (documentation of contrast dose, glomerular filtration rate, and PCI indication; appropriate indication for elective PCI; and use of embolic protection device), and a composite of all process measures. We calculated weighted pair-wise correlations between each set of process metrics and performed weighted correlation analyses to assess the association between composite measure performance with corresponding 30-day risk-standardized mortality and readmission rates. We reported the variance in risk-standardized 30-day outcome rates explained by process measures. We analyzed 1 268 860 PCIs from 1331 hospitals. For many process measures, median hospital performance exceeded 90%. We found strong correlations between medication-specific process measures (P<0.01) and weak correlations between hospital performance on the newly proposed and established process measures. The composite process measure explained only 1.3% and 2.0% of the observed variation in mortality and readmission rates, respectively.

Conclusions: Hospital performance on many PCI-specific process measures demonstrated little opportunity for improvement and explained only a small percentage of hospital variation in 30-day outcomes. Efforts to measure and improve hospital quality for PCI patients should focus on both process and outcome measures.

Keywords: outcomes; percutaneous coronary interventions; process measures; readmissions.

MeSH terms

  • Cardiac Rehabilitation / standards
  • Coronary Disease / diagnosis
  • Coronary Disease / mortality
  • Coronary Disease / therapy*
  • Cross-Sectional Studies
  • Healthcare Disparities / standards
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Medicare
  • Patient Discharge / standards
  • Patient Readmission / standards
  • Percutaneous Coronary Intervention / adverse effects
  • Percutaneous Coronary Intervention / mortality
  • Percutaneous Coronary Intervention / standards*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Process Assessment, Health Care / standards*
  • Quality Improvement / standards*
  • Quality Indicators, Health Care / standards*
  • Referral and Consultation / standards
  • Registries
  • Risk Factors
  • Time Factors
  • Time-to-Treatment / standards
  • Treatment Outcome
  • United States

Substances

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Platelet Aggregation Inhibitors