Jones, DA;
Rathod, KS;
Koganti, S;
Lim, P;
Firoozi, S;
Bogle, R;
Jain, AK;
MacCarthy, PA;
Dalby, MC;
Malik, IS;
et al.
Jones, DA; Rathod, KS; Koganti, S; Lim, P; Firoozi, S; Bogle, R; Jain, AK; MacCarthy, PA; Dalby, MC; Malik, IS; Mathur, A; DeSilva, R; Rakhit, R; Kalra, SS; Redwood, S; Ludman, P; Wragg, A
(2019)
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.
Eur Heart J, 40 (31).
pp. 2620-2629.
ISSN 1522-9645
https://doi.org/10.1093/eurheartj/ehz152
SGUL Authors: Bogle, Richard
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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.
Item Type: | Article | ||||||||
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Additional Information: | This is a pre-copyedited, author-produced version of an article accepted for publication in European Heart Journal following peer review. The version of record Daniel A Jones, Krishnaraj S Rathod, Sudheer Koganti, Pitt Lim, Sam Firoozi, Richard Bogle, Ajay K Jain, Philip A MacCarthy, Miles C Dalby, Iqbal S Malik, Anthony Mathur, Ranil DeSilva, Roby Rakhit, Sundeep Singh Kalra, Simon Redwood, Peter Ludman, Andrew Wragg, 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, European Heart Journal, Volume 40, Issue 31, 14 August 2019, Pages 2620–2629 is available online at: https://doi.org/10.1093/eurheartj/ehz152 | ||||||||
Keywords: | Outcomes, Percutaneous coronary intervention, Acute Coronary Syndrome, Aged, Angina, Stable, Cardiologists, Cardiovascular Diseases, Case-Control Studies, Cerebrovascular Disorders, Clinical Decision-Making, Female, Hospital Mortality, Humans, Interrupted Time Series Analysis, Male, Mandatory Reporting, Middle Aged, Patient Care Management, Percutaneous Coronary Intervention, Professional Misconduct, Prospective Studies, Quality Improvement, Registries, Risk Factors, Treatment Outcome, United Kingdom, Humans, Cerebrovascular Disorders, Cardiovascular Diseases, Treatment Outcome, Registries, Hospital Mortality, Risk Factors, Case-Control Studies, Prospective Studies, Mandatory Reporting, Professional Misconduct, Aged, Middle Aged, Patient Care Management, Female, Male, Acute Coronary Syndrome, Quality Improvement, Angina, Stable, Percutaneous Coronary Intervention, Interrupted Time Series Analysis, Clinical Decision-Making, United Kingdom, Cardiologists, Outcomes, Percutaneous coronary intervention, Outcomes, Percutaneous coronary intervention, 1102 Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology | ||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Institute of Medical & Biomedical Education (IMBE) | ||||||||
Journal or Publication Title: | Eur Heart J | ||||||||
ISSN: | 1522-9645 | ||||||||
Language: | eng | ||||||||
Dates: |
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Publisher License: | Publisher's own licence | ||||||||
PubMed ID: | 31220238 | ||||||||
Web of Science ID: | WOS:000490151500015 | ||||||||
Go to PubMed abstract | |||||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/112954 | ||||||||
Publisher's version: | https://doi.org/10.1093/eurheartj/ehz152 |
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