Facility-Level Variation in Hospitalization, Mortality, and Costs in the 30 Days After Percutaneous Coronary Intervention

Circulation ◽  
2015 ◽  
Vol 132 (2) ◽  
pp. 101-108 ◽  
Author(s):  
Steven M. Bradley ◽  
Colin I. O’Donnell ◽  
Gary K. Grunwald ◽  
Chuan-Fen Liu ◽  
Paul L. Hebert ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Level Variation ◽  
Percutaneous Coronary ◽  
Facility Level

Abstract 15330: Association Between Elective Percutaneous Coronary Intervention Appropriateness and Publicly Reported Outcomes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Vinay Kini ◽  
Paul Hess ◽  
Wenhui Liu ◽  
Gary Grunwald ◽  
Michael Ho ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Proportional Hazards ◽  
Coronary Intervention ◽  
Cox Proportional Hazards ◽  
Veterans Administration ◽  
Elective Percutaneous Coronary Intervention ◽  
Percutaneous Coronary ◽  
National Cohort ◽  
Risk Patients ◽  
Facility Level

Introduction: Public reporting of percutaneous coronary intervention (PCI) outcomes such as readmission and mortality may cause harm by adversely affecting patient selection for PCI. Little is known about the relationship between these outcomes and elective PCI appropriateness - a validated metric of PCI quality. Methods: We identified all patients in the national Veterans Administration healthcare system who underwent elective PCI for stable coronary disease between 2013 and 2015. We defined PCI appropriateness using 2012 criteria. The primary outcome was 90-day all-cause hospitalization or mortality. We used hierarchical Cox proportional hazards regression models adjusted for patient- and facility-level covariates to compare outcomes across PCI appropriateness categories, and a joint survival/logistic model to compare facility-level variation in inappropriate PCI and 90-day outcomes. Results: Among 2,561 patients (mean age 66 years, 99% men) undergoing PCI across 59 sites, 29.6% were classified as appropriate, 10.4% as inappropriate, and 60% as uncertain. The proportion of patients who were readmitted or died were 15.6%, 16.4%, and 15.3% among patients who received appropriate, inappropriate, and uncertain PCI respectively. There were no significant differences in 90-day outcomes between the groups (hazard ratio for appropriate compared to inappropriate PCI 0.82 [CI 0.57 to 1.17; p=0.28]). The site level covariance between inappropriate PCI and 90-day outcomes was -0.033 (95% CI -0.117 to 0.047), indicating no site-level correlation between appropriateness and 90-day outcomes (Figure). Conclusion: We found no association between elective PCI appropriateness and 90-day outcomes among a national cohort of Veterans. Including appropriateness in public reports may 1) characterize PCI quality more fully and 2) potentially mitigate the harms of reporting outcomes by empowering providers to perform appropriate PCI in higher-risk patients.

Abstract 14590: Cardiac Rehabilitation Utilization After Percutaneous Coronary Intervention Remains Exceedingly Low and is Strongly Associated With the Treating Hospital and Operator: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Devraj Sukul ◽  
Milan Seth ◽  
Michael Thompson ◽  
Steven J KETEYIAN ◽  
Thomas F Boyden ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiac Rehabilitation ◽  
Patient Characteristics ◽  
Coronary Intervention ◽  
Level Variation ◽  
Clinical Registry ◽  
Hospital Referral ◽  
Percutaneous Coronary ◽  
Blue Cross Blue Shield ◽  
Blue Shield

Introduction: Despite its proven benefits, cardiac rehabilitation (CR) use remains low. Identifying the sources of variation in CR referral and downstream use may help direct policies and quality improvement efforts. Objectives: We sought to quantify the magnitude of hospital and operator-level variation in CR referral and utilization after percutaneous coronary intervention (PCI). Methods: We used clinical registry data from patients (pts) discharged after PCI between 1/2012 and 10/2016 at 32 Michigan hospitals performing at least 100 PCIs linked to Blue Cross Blue Shield or Medicare claims. Registry and claims data were used to identify (i) CR referral prior to discharge and (ii) any CR use within 90 days after discharge. We calculated hospital-level risk and reliability adjusted rates of CR referral and utilization with Bayesian hierarchical regression models adjusted for patient characteristics and clustering by hospital and operator. Median odds ratios (MORs) with 95% credible intervals (CI) measured variation attributable to hospitals and operators. Results: Among 33,593 pts with a valid zip code and discharged home after PCI, 76.4% received an in-hospital referral for CR. Overall CR use was 26.7% and 31.3% among those who received an in-hospital referral. Adjusted rates of CR referral and use across hospitals ranged from 1.0%-100% and 14.9%-73.9%, respectively (Fig). After adjusting for pt factors, there was significant hospital and operator-level variation in CR referral with MORs of 5.91 (95% CI 4.02-9.34) and 1.71 (95% CI 1.60-1.85), respectively. There was also significant hospital and operator-level variation in CR use with MORs of 1.99 (95% CI 1.67 - 2.46) and 1.36 (95% CI 1.29 - 1.44), respectively. Conclusions: We found significant hospital and operator-level variation not only in post-PCI CR referral, but also CR utilization. Multi-faceted interventions targeting hospitals and PCI operators are needed to improve CR use after PCI.

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