A Survey of Interventional Cardiologists’ Attitudes and Beliefs About Public Reporting of Percutaneous Coronary Intervention

Blumenthal, Daniel M.; Valsdottir, Linda R.; Zhao, Yuansong; Shen, Changyu; Kirtane, Ajay J.; Pinto, Duane S.; Resnic, Fred; Maddox, Karen E. Joynt; Wasfy, Jason H.; Mehran, Roxana; Rosenfield, Ken; Yeh, Robert W.

doi:10.1001/jamacardio.2018.1095

Cited by 38 publications

(35 citation statements)

References 16 publications

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“…One concern is that care for cardiac arrest patients at specialized centers will adversely affect their reported mortality . For example, Peberdy et al attempted to estimate how increasing numbers of cardiac arrest patients with STEMI would affect hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

Association of acute myocardial infarction cardiac arrest patient volume and in‐hospital mortality in the United States: Insights from the National Cardiovascular Data Registry Acute Coronary Treatment And Intervention Outcomes Network Registry

Kontos

Fordyce

Chen

et al. 2019

Clinical Cardiology

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Background Little is known about how differences in out of hospital cardiac arrest patient volume affect in‐hospital myocardial infarction (MI) mortality. Hypothesis Hospitals accepting cardiac arrest transfers will have increased hospital MI mortality. Methods MI patients (ST elevation MI [STEMI] and non‐ST elevation MI [NSTEMI]) in the Acute Coronary Treatment Intervention Outcomes Network Registry were included. Hospital variation of cardiac arrest and temporal trend of the proportion of cardiac arrest MI patients were explored. Hospitals were divided into tertiles based on the proportion of cardiac arrest MI patients, and association between in‐hospital mortality and hospital tertiles of cardiac arrest was compared using logistic regression adjusting for case mix. Results A total of 252 882 patients from 224 hospitals were included, of whom 9682 (3.8%) had cardiac arrest (1.6% of NSTEMI and 7.5% of STEMI patients). The proportion of MI patients who had cardiac arrest admitted to each hospital was relatively low (median 3.7% [25th, 75th percentiles: 3.0%, 4.5%]).with a range of 4.2% to 12.4% in the high‐volume tertiles. Unadjusted in‐hospital mortality increased with tertile: low 3.8%, intermediate 4.6%, and high 4.7% ( P < 0.001); this was no longer significantly different after adjustment (intermediate vs high tertile odds ratio (OR) = 1.02; 95% confidence interval [0.90‐1.16], low vs high tertile OR = 0.93 [0.83, 1.05]). Conclusions The proportion of MI patients who have cardiac arrest is low. In‐hospital mortality among all MI patients did not differ significantly between hospitals that had increased proportions of cardiac arrest MI patients. For most hospitals, overall MI mortality is unlikely to be adversely affected by treating cardiac arrest patients with MI.

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Section: Discussionmentioning

confidence: 99%

Association of acute myocardial infarction cardiac arrest patient volume and in‐hospital mortality in the United States: Insights from the National Cardiovascular Data Registry Acute Coronary Treatment And Intervention Outcomes Network Registry

Kontos

Fordyce

Chen

et al. 2019

Clinical Cardiology

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“…3–7 Furthermore, in a recent survey, most interventional cardiologists admitted to, at times, not performing high-risk but indicated PCIs because they were concerned that a bad outcome might negatively affect their publicly reported outcomes. 8,9 This evidence of physician risk aversion suggests that transparency may impose a powerful incentive to avoid public shame, altering physicians’ clinical decision making in a manner that can be ultimately harmful to patient care. 10 …”

Section: Current State Of Pci Public Reporting Initiativesmentioning

confidence: 99%

“…However, the better outcomes noted in this procedure-based analysis likely reflect some degree of case selection. 11 Collectively, the evidence to date suggests that public reporting impedes access to potentially life-saving interventions for the critically ill. 3–5,8,9 …”

Section: Current State Of Pci Public Reporting Initiativesmentioning

confidence: 99%

“…In addition, given that fear of public shame is likely what drives physicians to alter their clinical decision making, particularly concerning high-risk patients, and potentially compels them to upcode documentation, completely removing the “public” element of reporting might help address these behaviors. 8,9,31 This change may have minimal implications for patient behavior given evidence that patients do not often read these reports. 8 By facilitating peer-driven analyses of performance and quality improvement, nonpublic reporting among institutions might motivate the “positive” behavioral changes among clinicians that original reporting initiatives intended and might diminish the “negative” behaviors driven by fear of public or media embarrassment.…”

Section: Future Public Reporting Initiativesmentioning

confidence: 99%

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Public Reporting of Percutaneous Coronary Intervention Outcomes

et al. 2018

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IMPORTANCE More than 20 years have passed since public reporting of percutaneous coronary intervention (PCI) outcomes first began in New York State, but reporting remains a polarizing issue. OBSERVATIONS Advocates of public reporting point to the strong incentive that public disclosure of outcomes data provides for institutions and clinicians to improve clinical care and to the importance of enabling patients to make informed choices about their care. Critics highlight the methodological challenges that impede fair and accurate assessments of care quality as well as reporting’s unintended consequences. Public reporting of PCI outcomes has only been implemented in 5 states, but reporting efforts for multiple conditions and procedures are now proliferating nationally, propelled by the notion that transparency improves the quality of health care and fosters trust in health care institutions. Careful evaluation of the evidence to date for PCI in particular, however, suggests that enthusiasm for such efforts should be tempered. CONCLUSIONS AND RELEVANCE Public reporting has not achieved its primary objectives. Policy makers should consider variations of reporting that might strengthen care quality, empower patients, and mitigate undesirable repercussions.

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“…Specifically, concerns have been raised that operators in public reporting states more frequently consciously “game the system” or unconsciously avoid pursuing appropriate and indicated treatment in high‐risk scenarios due to concerns about their RAMR and “public shame”. In fact, in a recent analysis, 65% of interventional cardiologists surveyed in Massachusetts and New York admitted to avoiding PCI at least twice over concerns about the potential negative impact of a bad outcome . Unfortunately, it is just such high‐risk patients who have the largest mortality benefit from PCI, a conundrum known as the “risk‐treatment paradox”, wherein those with the highest potential mortality benefit from treatment simultaneously have the worst overall outcomes following treatment.…”

Section: Introductionmentioning

confidence: 99%