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Angioplasty Rate Affected by Reporting Requirements
BOSTON — Mandatory public reporting appears to make it less likely that patients entering hospitals with heart attacks receive angioplasties, according to a new study from Harvard School of Public Health, Brigham and Women’s Hospital and the VA Boston Healthcare System.M
ost affected were “high-risk” patients who had suffered massive heart attacks, according to the study, which appeared in the Oct. 10, 2012, edition of the Journal of the American Medical Association.1
“Making performance data available to patients is very important. It helps them choose the best healthcare,” said co-author Karen Joynt, MD. “However, the results of our study make us wonder if we're doing public reporting as well as we could be.”
The study sought to determine whether hospitals concerned about receiving negative ratings in public reports would be less inclined to offer these procedures to very sick patients. Currently, only three states require public reporting of patient outcomes after percutaneous coronary intervention (PCI), but many states have voluntary reporting programs, and many more are considering implementing such programs.
Joynt and co-author Ashish Jha, MD, a staff physician at the Boston VAMC, analyzed data from patients older than 65 years of age who had suffered heart attacks in the three states requiring public reporting — Massachusetts, New York and Pennsylvania — from 2002-2010. Those results were compared with patients in seven nonreporting states in the same region.
Overall, Medicare patients with heart attacks in those three states had 18% lower odds of receiving PCI than patients in states without public reporting, the researchers found.
The differences were even more dramatic for extremely sick patients who had suffered damaging heart attacks; they had about 27% lower odds of receiving angioplasty. Patients presenting with cardiac arrest or in shock had about 21% lower odds of receiving PCI than comparable patients in other states.
In Massachusetts, the odds of receiving PCI compared with other states, dropped 19% after the public reporting program began.
Researchers questioned whether physicians were concerned about the risk of poor outcomes if they performed the procedure or if they had deemed them futile.
“It will be important for follow-up work to determine why this is going on, and, more importantly, how we can address it,” Joynt said.
Jha said the results could be a cautionary tale for those states considering implementing reporting programs and that policies might need to be evaluated carefully to prevent unintended consequences.
“Improving transparency of the healthcare system is critical,” he said. “However, we have to make sure we do it right. Otherwise we risk creating incentives to deny care to the sickest patients.”
1. Joynt K, Blumenthal DM, Oray J, et. al. Association of Public Reporting for Percutaneous Coronary Intervention With Utilization and Outcomes Among Medicare Beneficiaries With Acute Myocardial Infarction.JAMA. 2012;308(14):1460-1468. doi:10.1001/jama.2012.12922.