Public reporting of outcomes is designed to motivate clinicians to improve performance, and allow patients to choose high quality hospitals. However, it has also been proposed that these measures prevent physicians from undertaking high-risk cases. The purpose of this study was to determine whether public reporting for percutaneous coronary intervention (PCI) is associated with lower rates of PCI for patients with acute myocardial infarction (MI), or with higher mortality rates in this population.
Data were obtained for fee-for-service Medicare patients who were admitted with acute MI in the US between 2002 and 2010. Logistic regression was used to compare PCI and mortality rates between reporting states and nonreporting states. The main mortality outcome measures were risk-adjusted PCI and mortality rates.
In 2010, patients with acute MI were less likely to receive PCI in public reporting states that in nonreporting states (P=0.003). The greatest differences were noted among 6078 patients with ST-segment elevation MI (P=.002), and the 2194 patients with cardiogenic shock or cardiac arrest (P=.03). However, no differences in mortality were noted. After implementation of public reporting in Massachusetts, the odds of undergoing PCI decreased compared to non-reporting states (P=.03).
Although there was no overall difference in acute MI mortality between states with and without public reporting, the use of PCI for was lower in three states with public reporting of PCI outcomes.
- Joynt KE, Blumenthal DM, Orav EJ et al. Association of Public Reporting for Percutaneous Coronary Intervention With Utilization and Outcomes Among Medicare Benificiaries With Acute Myocardial Infarction. JAMA 2012;308:1460-1468.