Impact of the New York State Cardiac Surgery and Percutaneous Coronary Intervention Reporting System on the management of patients with acute myocardial infarction complicated by cardiogenic shock

Apolito, Renato; Greenberg, Mark A.; Menegus, Mark; Lowe, April M.; Sleeper, Lynn A.; Goldberger, M.; Remick, J.S.; Radford, Martha J.; Hochman, Judith S.

doi:10.1016/j.ahj.2007.10.013

Cited by 106 publications

(91 citation statements)

References 27 publications

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“…Penalizing operators for non‐procedural‐related readmissions may have a negative effect on quality of care, given that providers may select against doing procedures in patients with complicated medical comorbidities, while these are the patients that may benefit the most from intervention. The focus in this population should be on treating their underlying medical illnesses, improving outpatient wound care, and pain management rather than simply reducing readmissions 10, 17, 18…”

Section: Discussionmentioning

confidence: 99%

Hospital Readmissions Following Endovascular Therapy for Critical Limb Ischemia: Associations With Wound Healing, Major Adverse Limb Events, and Mortality

Reed

Raeisi‐Giglou

Kafa

et al. 2016

JAHA

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BackgroundThe significance of hospital readmission after endovascular therapy for critical limb ischemia (CLI) is not well established. We sought to investigate the incidence, timing, and causes of readmissions after endovascular therapy for CLI and whether readmission is associated with major adverse limb events (MALE) or mortality.Methods and ResultsThis was a retrospective study of 252 patients treated with endovascular therapy for CLI. During median follow‐up of 381 days (interquartile range [IQR], 115–718), 140 (56%) were readmitted, with median time to readmission of 83 days (IQR, 33–190). Readmission within 30 days occurred in 14% of patients (n=35; 25% of readmissions). Most readmissions occurred between 30 and 180 days (n=67; 48% of readmissions). The most frequent reason for readmission was unhealed wounds (n=63; 45% of readmissions). Independent predictors of readmission by Cox proportional hazards analysis were unhealed wounds, presence of multiple wounds, age ≥70, female sex, hemodialysis, and history of heart failure (P<0.05 for each). By Kaplan–Meier analysis, readmission was greatest in patients with unhealed wounds, followed by patients who never had a wound, and lowest in patients whose wounds completely healed (P<0.0001 overall, and P<0.01 between groups). After multivariable adjustment, readmission remained an independent predictor of composite MALE (major amputation, bypass, or endarterectomy) or mortality (adjusted hazard ratio, 3.1; 95% CI, 1.5–6.5; P=0.002).ConclusionsMost readmissions occur 30 and 180 days after endovascular therapy for nonprocedural reasons. Unhealed wounds are an independent risk factor for readmission. Readmission is associated with increased MALE and mortality after endovascular therapy for CLI.

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Section: Discussionmentioning

confidence: 99%

Hospital Readmissions Following Endovascular Therapy for Critical Limb Ischemia: Associations With Wound Healing, Major Adverse Limb Events, and Mortality

Reed

Raeisi‐Giglou

Kafa

et al. 2016

JAHA

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“…registry comparing the outcomes of patients from New York with those from other states [16]. In New York, patients presenting with cardiogenic shock were less likely to receive angiography, PCI, or CABG.…”

Section: Concerns Related To Public Reportingmentioning

confidence: 99%

Public Reporting of Cardiovascular Care: An Opportunity to Shape the Future

Marshall

Zoghbi

Gillis

2013

Cathet Cardio Intervent

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“…Outcomes reporting would in theory allow the most appropriate selection of high quality hospitals and providers for referrals. However, such reporting at this point remains problematic for the reasons described above, and one of the few large-scale experiences reported to date confirms that access for high-risk patients may be adversely impacted [14].…”

Section: Assessing Qualitymentioning

confidence: 99%

“…In the 1990s, the volume-outcome relationship in cardiac surgery was judged to be sufficiently strong that the New York State Department of Health now publishes annual volume and mortality rates for every cardiac surgeon and interventional cardiologist in the state [14]. The Leapfrog Group, a coalition of 160 large payors who purchase insurance for over 34 million Americans, has created formal designations for highvolume centers for 5 complex procedures and high-risk obstetric care, and explicitly encourages volume-based hospital referral among other initiatives [24].…”

Section: The Question Of Surgical Volumementioning

confidence: 99%

“…The results must be monitored carefully, both to verify that quality is actually improving, and to ensure that any gains in quality are not offset excessively by declines in access for patients who are high-risk and/or who are geographically or socioeconomically disadvantaged. A recent paper, for example, offers a caveat to public reporting of provider data, noting that since the advent of New York's reporting system for cardiac intervention, high-risk myocardial infarction patients in New York are half as likely as those in other states to receive angiographic intervention, and wait 10 times as long as those in other states for cardiac bypass [14]. In bladder cancer, likewise, concentration of treatment in higher volume centers may be expected to yield improved outcomes, but these improvements must be weighed against the risks entailed by potentially longer delays to cystectomy.…”

Section: Challenges and Conclusionmentioning

confidence: 99%

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Defining high quality health care

Cooperberg

Birkmeyer

Litwin

2009

Urologic Oncology: Seminars and Original Investigations

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Most health care quality improvement efforts target measures of health care structures, processes, and/or outcomes. Structural measures examine relatively fixed aspects of health care delivery such as physical plant and human resources. Process measures, the focus of the largest proportion of quality improvement efforts, assess specific transactions in clinical-patient encounters, such as use of appropriate surgical antibiotic prophylaxis, which are expected to improve outcomes. Outcome measures, which comprise quality of life endpoints as well as morbidity and mortality, are of greatest interest to clinicians and patients, but entail the greatest complexity, as the majority of variance in outcomes is attributable to patient and environmental factors that may not be readily modifiable. Selecting among structure, process, and outcome measures for quality improvement efforts generally will be dictated by the specific clinical situation for which improvement is desired.One aspect of health care quality that has received a great deal of attention in recent years is the relationship between surgical volume and health outcomes. Volume, an inherent characteristic of a health care facility or provider, is generally considered a structural measure of quality. Many studies have demonstrated a positive association between volume and outcomes, and policymakers in the private and public sectors have begun to consider volume in certification and reimbursement decisions. The volume-outcome association is not without controversy, however. Most studies in the field are limited by the nature of the administrative data on which they are based, and some studies have found that variation in quality within volume quantiles exceeds differences between quantiles. Moreover, regionalization driven by a focus on volume may exert adverse effects on access to care.The movement for health care quality improvement faces substantial methodological, clinical, financial, and political challenges. Despite these challenges, it is a movement that is gaining momentum, and the emphasis on quality in health care delivery is likely only to increase in the future. It is crucial, therefore, that physicians assume increasing leadership roles in efforts to define, measure, report, and improve quality of care.

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Impact of the New York State Cardiac Surgery and Percutaneous Coronary Intervention Reporting System on the management of patients with acute myocardial infarction complicated by cardiogenic shock

Cited by 106 publications

References 27 publications

Hospital Readmissions Following Endovascular Therapy for Critical Limb Ischemia: Associations With Wound Healing, Major Adverse Limb Events, and Mortality

Hospital Readmissions Following Endovascular Therapy for Critical Limb Ischemia: Associations With Wound Healing, Major Adverse Limb Events, and Mortality

Public Reporting of Cardiovascular Care: An Opportunity to Shape the Future

Defining high quality health care

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