Introduction:
New York State (NYS) publicly reports physician-level post-percutaneous coronary intervention (PCI) mortality at each individual site they practice, to empower patients to make informed decisions. Given that mortality is a rare event and some sites have low case volumes, we hypothesized that the reported data at each site for physicians practicing at multiple sites is highly unstable and thus misleading for patients. In this study, we examined variation in site-specific risk-adjusted mortality rates (RAMR) for physicians practicing at multiple sites in NYS.
Methods:
This study uses publicly reported 30-day physician-level RAMR for all PCI performed in NYS between 2014 and 2016. We obtained the site-specific RAMR (ssRAMR) at each hospital where the physician performed PCI, and overall mean RAMR (mRAMR) for the physician. We excluded physicians who performed PCI at only one hospital. We identified outliers for mRAMR and maximum ssRAMR if values were greater than the 95
th
percentile for each measure and plotted the outliers.
Results:
Between 2014 and 2016, 142,853 PCI procedures were performed by 373 physicians at 61 hospitals. Among 207 (55.5%) physicians practicing at multiple sites who performed 82,075 PCI (57.5%), the median mRAMR was 1.11% (IQR 0.66-1.60%, range 0-5.33%) and the median ssRAMR was 0.52% (IQR 0-1.53%, range 0-47.69%). Among the 11 physicians classified as ssRAMR outliers, only 3 (27.2%) physicians were also classified as an mRAMR outlier.
Conclusion:
We found that the individual ssRAMRs reported for a physician practicing at multiple hospitals is highly variable, and that mRAMR and ssRAMR outlier status are not consistent with each other. Thus, we believe public reporting of ssRAMR in NYS does not adequately reflect the quality of care delivered by physicians performing PCI.
Figure:
mRAMR and ssRAMR among maximum ssRAMR outliers. Each letter (A-K) represents a separate outlier physician.
Tree-structured risk stratification of in-hospital mortality after percutaneous coronary intervention for acute myocardial infarction: A report from the New York State percutaneous coronary intervention database
