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

Sandhu AT, Kohsaka S, Bhattacharya J, Fearon WF, Harrington RA, Heidenreich PA. Association Between Current and Future Annual Hospital Percutaneous Coronary Intervention Mortality Rates. JAMA cardiology. 2019 Nov 1; 4(11):1077-1083.

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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.