Taking the “Public” Out of Public Reporting of Percutaneous Coronary Intervention

Wadhera, Rishi K.; Bhatt, Deepak L.

doi:10.1001/jama.2017.12087

Cited by 14 publications

(20 citation statements)

References 9 publications

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“…2–4 These findings may no longer hold true, as hospitals have increasingly been required to participate in national quality improvement initiatives, such as pay-for-performance, public reporting, and readmission reduction programs, and because the USNWR methods have evolved in recent years. 5,6 …”

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confidence: 99%

Association of Rankings With Cardiovascular Outcomes at Top-Ranked Hospitals vs Nonranked Hospitals in the United States

2018

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IMPORTANCE The US News & World Report (USNWR) identifies the “Best Hospitals” for “Cardiology and Heart Surgery.” These rankings may have significant influence on patients and hospitals. OBJECTIVE To determine whether USNWR top-ranked hospitals perform better than nonranked hospitals on mortality rates and readmission measures as well as patient satisfaction. DESIGN, SETTING, AND PARTICIPANTS This national retrospective study evaluated outcomes at 3552 US hospitals from 2014 to 2017. EXPOSURES US News & World Report 2018 to 2019 Cardiology and Heart Surgery rankings (top-ranked vs nonranked hospitals). MAIN OUTCOMES AND MEASURES Hospital-level 30-day risk-standardized mortality and readmission rates for Medicare fee-for-service beneficiaries age 65 years or older hospitalized for 3 cardiovascular conditions: acute myocardial infarction (AMI), heart failure (HF), and coronary artery bypass grafting (CABG) as well as Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction star ratings obtained from publicly available Centers for Medicaid and Medicare Services data. RESULTS Thirty-day mortality rates at top-ranked hospitals (n = 50), compared with nonranked hospitals (n = 3502), were lower for AMI (11.9% vs 13.2%, P < .001), HF (9.5% vs 11.9%; P < .001), and CABG (2.3%vs 3.3%; P < .001). Thirty-day readmission rates at the top-ranked hospitals (n = 50) when compared with nonranked hospitals (n = 2841) were similar for AMI (16.7% vs 16.5%; P = .64) and CABG (14.1% vs 13.7%; P = .15) but higher for HF (21.0% vs 19.2%; P < .001), Finally, patient satisfaction was higher at top-ranked hospitals (n = 50) compared with nonranked hospitals (n = 3412) (3.9 vs 3.3; P < .001). CONCLUSIONS AND RELEVANCE We found that USNWR top-ranked hospitals for cardiovascular care had lower 30-day mortality rates for AMI, HF, and CABG and higher patient satisfaction ratings compared with nonranked hospitals. However, 30-day readmission rates were either similar (for AMI and CABG) or higher (for HF) at top-ranked compared with nonranked hospitals. This discrepancy between readmissions and other performance measures raises concern that readmissions may not be an adequate metric of hospital care quality.

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Association of Rankings With Cardiovascular Outcomes at Top-Ranked Hospitals vs Nonranked Hospitals in the United States

2018

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“…In a recent survey of interventional cardiologists in Massachusetts and New York, a majority (75%) admitted to, at times, not performing high-risk, but indicated, PCIs due to concern that doing so might negatively impact their publicly reported outcomes (7). As a result, some have argued that reporting simply impedes access to care for critically ill patients and potentially results in harm (8). Our study raises concern that this policy, which has not clearly improved patient outcomes, has also imposed financial and administrative burden on physicians and institutions.…”

Section: Discussionmentioning

confidence: 99%

Public Reporting of Percutaneous Coronary Intervention Outcomes

Wadhera

O’Brien

Maddox

et al. 2019

Journal of the American College of Cardiology

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“…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%

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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Taking the “Public” Out of Public Reporting of Percutaneous Coronary Intervention

Cited by 14 publications

References 9 publications

Association of Rankings With Cardiovascular Outcomes at Top-Ranked Hospitals vs Nonranked Hospitals in the United States

Association of Rankings With Cardiovascular Outcomes at Top-Ranked Hospitals vs Nonranked Hospitals in the United States

Public Reporting of Percutaneous Coronary Intervention Outcomes

Public Reporting of Percutaneous Coronary Intervention Outcomes

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