Friday, March 13, 2009

PCI mortality data more likely to improve provider quality than inform consumer choice
By Maggie De Pano, DCRI Communications

It is now common practice for U.S. hospitals to report the number of patients who die under their care. The Center for Medicare and Medicaid Services routinely reports 30-day hospital mortality rates for heart attacks and heart failure, and will soon add deaths that take place during percutaneous coronary intervention (PCI) procedures.

In a commentary published March 10 in the Journal of the American Journal of Cardiology, Robert M. Califf, MD and Eric D. Peterson, MD, discussed the implications of releasing PCI mortality data to the public. PCI is a therapeutic procedure used to treat narrowed arteries in the heart of patients with coronary heart disease.

Califf and Peterson noted that the disclosure of PCI information can be both good and bad, depending on the reason why it’s being done. Public reporting can supply a strong external motivation to implement quality improvement activities, but it will not necessarily give consumers the tools they need to select the best doctors and hospitals.

The authors wrote that death following a PCI procedure takes place most often when it is done under urgent or emergency conditions, when the consumer’s ability to choose a doctor or hospital is irrelevant. On the other hand, when PCI is done as an elective procedure, complications are exceedingly rare, making it unlikely that provider quality can be differentiated from other chance events. Yet while public reporting may not necessarily inform consumer choice, it can still reinforce doctors’ and hospital administrators’ interest in preventing errors.

In this regard, Califf and Peterson supported state and national efforts that require hospitals to collect and compare PCI information, argued for better and more complete analysis of outcomes specific to medical conditions, and encouraged the inclusion of data on care processes and appropriateness to any outcomes reporting system. They also highlighted the importance of performing PCI procedures on patients who will likely benefit from them.

Lastly, the authors called for more extensive public and provider education, better methods for summarizing complex and multi-dimensional data on care structure, processes, and outcomes into composite measures, and regulations designed to prevent providers from using misleading comparisons of quality data to improve market share.

Read the full commentary.