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Original Investigation
September 18, 2019

Association Between Current and Future Annual Hospital Percutaneous Coronary Intervention Mortality Rates

Author Affiliations
  • 1Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
  • 2Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
  • 3Center for Health Policy, Department of Medicine, Stanford University, Stanford, California
  • 4Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University, Stanford, California
  • 5Veterans Affairs Palo Alto Health Care System, Palo Alto, California
JAMA Cardiol. Published online September 18, 2019. doi:https://doi.org/10.1001/jamacardio.2019.3221
Key Points

Question  Are publicly reported measures of a hospital’s 30-day all-cause mortality after percutaneous coronary intervention associated with its mortality rates in subsequent years?

Findings  In this study, on the basis of risk-adjusted percutaneous coronary intervention–related mortality rates from 1998 to 2016 at 67 New York hospitals (960 hospital-years), the hospital observed to expected mortality ratio was weakly associated with the ratio in the following year. Hospitals identified as outliers with high or low mortality experienced regression to the mean the following year.

Meaning  Annual hospital-level percutaneous coronary intervention–related mortality rates were poorly associated with future performance but may not be useful for helping patients identify high-quality, low-mortality care.

Abstract

Importance  Multiple states publicly report a hospital’s risk-adjusted mortality rate for percutaneous coronary intervention (PCI) as a quality measure. However, whether reported annual PCI mortality is associated with a hospital’s future performance is unclear.

Objective  To evaluate the association between reported risk-adjusted hospital PCI-related mortality and a hospital’s future PCI-related mortality.

Design, Setting, and Participants  This study used data from the New York Percutaneous Intervention Reporting System from January 1, 1998, to December 31, 2016, to assess hospitals that perform PCI.

Exposures  Public-reported, risk-adjusted, 30-day mortality after PCI.

Main Outcomes and Measures  The primary analysis evaluated the association between a hospital’s reported risk-adjusted PCI-related mortality and future PCI-related mortality. The correlation between a hospital’s observed to expected (O/E) PCI-related mortality rates each year and future O/E mortality ratios was assessed. Multivariable linear regression was used to examine the association between index year O/E mortality and O/E mortality in subsequent years while adjusting for PCI volume and patient severity.

Results  This study included 67 New York hospitals and 960 hospital-years. Hospitals with low PCI-related mortality (O/E mortality ratio, ≤1) and high mortality (O/E mortality ratio, >1) had inverse associations between their O/E mortality ratio in the index year and the subsequent change in the ratio (hospitals with low mortality, r = −0.45; hospitals with high mortality, r = −0.60). Little of the variation in risk-adjusted mortality was explained by prior performance. An increase in the O/E mortality ratio from 1.0 to 2.0 in the index year was associated with a higher O/E mortality ratio of only 0.15 (95% CI, 0.02-0.27) in the following year.

Conclusions and Relevance  At hospitals with high or low PCI-related mortality rates, the rates largely regressed to the mean the following year. A hospital’s risk-adjusted mortality rate was poorly associated with its future mortality. The annual hospital PCI-related mortality may not be a reliable factor associated with hospital quality to consider in a practice change or when helping patients select high-quality hospitals.

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