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- Title
The association between the public reporting of individual operator outcomes with patient profiles, procedural management, and mortality after percutaneous coronary intervention: an observational study from the Pan-London PCI (BCIS) Registry using an interrupted time series analysis
- Authors
Jones, Daniel A; Rathod, Krishnaraj S; Koganti, Sudheer; Lim, Pitt; Firoozi, Sam; Bogle, Richard; Jain, Ajay K; MacCarthy, Philip A; Dalby, Miles C; Malik, Iqbal S; Mathur, Anthony; DeSilva, Ranil; Rakhit, Roby; Kalra, Sundeep Singh; Redwood, Simon; Ludman, Peter; Wragg, Andrew
- Abstract
Aims The public reporting of healthcare outcomes has a number of potential benefits; however, unintended consequences may limit its effectiveness as a quality improvement process. We aimed to assess whether the introduction of individual operator specific outcome reporting after percutaneous coronary intervention (PCI) in the UK was associated with a change in patient risk factor profiles, procedural management, or 30-day mortality outcomes in a large cohort of consecutive patients. Methods and results This was an observational cohort study of 123 780 consecutive PCI procedures from the Pan-London (UK) PCI registry, from January 2005 to December 2015. Outcomes were compared pre- (2005–11) and post- (2011–15) public reporting including the use of an interrupted time series analysis. Patients treated after public reporting was introduced were older and had more complex medical problems. Despite this, reported in-hospital major adverse cardiovascular and cerebrovascular events rates were significantly lower after the introduction of public reporting (2.3 vs. 2.7%, P < 0.0001). Interrupted time series analysis demonstrated evidence of a reduction in 30-day mortality rates after the introduction of public reporting, which was over and above the existing trend in mortality before the introduction of public outcome reporting (35% decrease relative risk 0.64, 95% confidence interval 0.55–0.77; P < 0.0001). Conclusion The introduction of public reporting has been associated with an improvement in outcomes after PCI in this data set, without evidence of risk-averse behaviour. However, the lower reported complication rates might suggest a change in operator behaviour and decision-making confirming the need for continued surveillance of the impact of public reporting on outcomes and operator behaviour. View large Download slide View large Download slide
- Publication
European Heart Journal, 2019, Vol 40, Issue 31, p2620
- ISSN
0195-668X
- Publication type
Article
- DOI
10.1093/eurheartj/ehz152