Daniel A Jones1, Krishnaraj S Rathod1, Sudheer Koganti1, Pitt Lim2, Sam Firoozi2, Richard Bogle2, Ajay K Jain1, Philip A MacCarthy3, Miles C Dalby4, Iqbal S Malik5, Anthony Mathur1, Ranil DeSilva4, Roby Rakhit6, Sundeep Singh Kalra6, Simon Redwood7, Peter Ludman8, Andrew Wragg1. 1. Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK. 2. Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, Blackshaw Road, Tooting, London, UK. 3. Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, Denmark Hill, 10 Cutcombe Road, London, UK. 4. Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Middlesex, UK. 5. Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, Du Cane Road, London, UK. 6. Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, UK. 7. Department of Cardiology, St Thomas' NHS Foundation Trust, Guys & St. Thomas Hospital, Westminster Bridge Rd, London, UK. 8. Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, UK.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
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. Published on behalf of the European Society of Cardiology. All rights reserved.