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ASSOCIATIONS OF HOSPITAL STRATEGIES AND 30-DAY RISK-STANDARDIZED MORTALITY RATES IN PERCUTANEOUS CORONARY INTERVENTION
34 JACC April 5, 2016 Volume 67, Issue 13
ACC.i2 Interventional Cardiology ASSOCIATIONS OF HOSPITAL STRATEGIES AND 30-DAY RISK-STANDARDIZED MORTALITY RATES IN PERCUTANEOUS CORONARY INTERVENTION Oral Contributions Room S104 Sunday, April 03, 2016, 9:00 a.m.-9:12 a.m. Session Title: Highlighted Original Research: ACC.i2 Interventional Cardiology and the Year in Review Abstract Category: 5. ACC.i2 Interventional Cardiology: Complex Patients/Comorbidities Presentation Number: 901-10 Authors: Jeptha Curtis, Karl E. Minges, Jeph Herrin, Nihar Desai, Brahmajee Nallamothu, John Rumsfeld, Mary Anne Elma, Peggy Chen, Henry Ting, John Messenger, Yale School of Medicine, New Haven, CT, USA Background: There is substantial variation in 30-day risk-standardized mortality rates (RSMR) for hospitals that perform percutaneous coronary intervention (PCI). We sought to identify hospital strategies most strongly associated with lower 30-day RSMR.
Methods: We surveyed 500 hospitals (81% response rate) participating in the National Cardiovascular Data Registry’s (NCDR) regarding their approaches to treating PCI patients. We performed weighted multivariate regression analysis using data from the CathPCI Registry to determine the association between specific hospital strategies and hospital 30-day RSMR.
Results: In multivariate analysis, 7 hospital strategies were significantly associated with lower RSMRs, including: 1) Conducting regular reviews of PCI appropriateness by an interdisciplinary team; 2) Engaging in quality improvement efforts targeted at reducing post-discharge mortality; 3) Use of the Plan-Do-Study-Act method of quality improvement; 4) Holding regular meetings with home health agencies to review the care of discharged cardiac patients; 5) Retaining high quality staff; 6) Having only few PCI patients cared for by a hospitalist; and 7) Performing most PCI procedures by a radial approach (all p<0.05). Hospitals varied in the numbers of strategies employed, and despite the effectiveness of strategies, few hospitals used more than 5 approaches (Figure). Conclusions: Specific hospital practices are associated with lower mortality for patients undergoing PCI.
ACC.i2 Interventional Cardiology ASSOCIATIONS OF HOSPITAL STRATEGIES AND 30-DAY RISK-STANDARDIZED MORTALITY RATES IN PERCUTANEOUS CORONARY INTERVENTION Oral Contributions Room S104 Sunday, April 03, 2016, 9:00 a.m.-9:12 a.m. Session Title: Highlighted Original Research: ACC.i2 Interventional Cardiology and the Year in Review Abstract Category: 5. ACC.i2 Interventional Cardiology: Complex Patients/Comorbidities Presentation Number: 901-10 Authors: Jeptha Curtis, Karl E. Minges, Jeph Herrin, Nihar Desai, Brahmajee Nallamothu, John Rumsfeld, Mary Anne Elma, Peggy Chen, Henry Ting, John Messenger, Yale School of Medicine, New Haven, CT, USA Background: There is substantial variation in 30-day risk-standardized mortality rates (RSMR) for hospitals that perform percutaneous coronary intervention (PCI). We sought to identify hospital strategies most strongly associated with lower 30-day RSMR.
Methods: We surveyed 500 hospitals (81% response rate) participating in the National Cardiovascular Data Registry’s (NCDR) regarding their approaches to treating PCI patients. We performed weighted multivariate regression analysis using data from the CathPCI Registry to determine the association between specific hospital strategies and hospital 30-day RSMR.
Results: In multivariate analysis, 7 hospital strategies were significantly associated with lower RSMRs, including: 1) Conducting regular reviews of PCI appropriateness by an interdisciplinary team; 2) Engaging in quality improvement efforts targeted at reducing post-discharge mortality; 3) Use of the Plan-Do-Study-Act method of quality improvement; 4) Holding regular meetings with home health agencies to review the care of discharged cardiac patients; 5) Retaining high quality staff; 6) Having only few PCI patients cared for by a hospitalist; and 7) Performing most PCI procedures by a radial approach (all p<0.05). Hospitals varied in the numbers of strategies employed, and despite the effectiveness of strategies, few hospitals used more than 5 approaches (Figure). Conclusions: Specific hospital practices are associated with lower mortality for patients undergoing PCI.