Changes in Percutaneous Coronary Interventions Deemed "Inappropriate" by Appropriate Use Criteria

被引：31

作者：

Hannan, Edward L. ^{[1
]}

Samadashvili, Zaza ^{[1
]}

Cozzens, Kimberly ^{[1
]}

Gesten, Foster ^{[2
]}

Osinaga, Alda ^{[3
]}

Fish, Douglas G. ^{[3
]}

Donahue, Constance L. ^{[3
]}

Bass, Ronald J. ^{[3
]}

Walford, Gary ^{[4
]}

Jacobs, Alice K. ^{[5
]}

Venditti, Ferdinand J. ^{[6
]}

Stamato, Nicholas J. ^{[7
]}

Berger, Peter B. ^{[8
]}

Sharma, Samin ^{[9
,11
,12
,13
,14
]}

King, Spencer B., III ^{[10
,15
,16
,17
,18
,19
]}

机构：

[1] SUNY Albany, Dept Hlth Policy Management & Behav, Albany, NY 12222 USA

[2] New York State Dept Hlth, Off Qual & Patient Safety, Albany, NY USA

[3] New York State Dept Hlth, Off Hlth Insurance Programs, Albany, NY USA

[4] Johns Hopkins Univ, Heart & Vasc Inst, Baltimore, MD USA

[5] Boston Med Ctr, Dept Cardiol, Boston, MA USA

[6] Albany Med Ctr, Dept Cardiol, Albany, NY USA

[7] Campbell Cty Mem Hosp, Dept Cardiol, Gillette, WY USA

[8] Northwell Hlth, Dept Cardiol, Great Neck, NY USA

[9] Mt Sinai Med Ctr, Clin Cardiol, New York, NY 10029 USA

[10] St Josephs Hlth Syst, Acad Affairs, Atlanta, GA USA

[11] Boston Sci Corp, Marlborough, MA USA

[12] Cardiovasc Syst Inc, St Paul, MN USA

[13] Abiomed, Danvers, MA USA

[14] Medicines Co, Parsippany, NJ USA

[15] Harvard Clin Res Inst, Data Safety Monitoring Board, Boston, MA USA

[16] Duke Univ, Data Safety Monitoring Board, Durham, NC 27706 USA

[17] Capicor Inc, Data Safety Monitoring Board, Beverly Hills, CA USA

[18] Merck & Co Inc, Data Safety Monitoring Board, Kenilworth, NJ USA

[19] Stentys, Data Safety Monitoring Board, Paris, France

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2017年 / 69卷 / 10期

关键词：

Medicaid; Percutaneous Coronary Interventions Reporting System; revascularization; stable coronary artery disease; REVASCULARIZATION; TRENDS;

D O I：

10.1016/j.jacc.2016.12.025

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Recent studies have demonstrated relatively high rates of percutaneous coronary interventions (PCIs) classified as "inappropriate." The New York State Department of Health shared rates with hospitals and announced the intention of withholding reimbursement pending demonstration of clinical rationale for Medicaid patients with inappropriate PCIs. OBJECTIVES The objective was to examine changes over time in the number and rate of inappropriate PCIs. METHODS Appropriate use criteria were applied to PCIs performed in New York in patients without acute coronary syndromes or previous coronary artery bypass graft surgery in periods before (2010 through 2011) and after (2012 through 2014) efforts were made to decrease inappropriateness rates. Changes in the number of appropriate PCIs were also assessed. RESULTS The percentage of inappropriate PCIs for all patients dropped from 18.2% in 2010 to 10.6% in 2014 (from 15.3% to 6.8% for Medicaid patients, and from 18.6% to 11.2% for other patients). The total number of PCIs in patients with no acute coronary syndrome/no prior coronary artery bypass graft surgery that were rated as inappropriate decreased from 2,956 patients in 2010 to 911 patients in 2014, a reduction of 69%. For Medicaid patients, the decrease was from 340 patients to 84 patients, a decrease of 75%. For a select set of higher-risk scenarios, there were higher numbers of appropriate PCIs per year in the period from 2012 to 2014. CONCLUSIONS The inappropriateness rate for PCIs and the use of PCI for elective procedures in New York has decreased substantially between 2010 and 2014. This decrease has occurred for a large proportion of PCI hospitals. (J Am Coll Cardiol 2017; 69: 1234-42) (C) 2017 by the American College of Cardiology Foundation.

引用

页码：1234 / 1242

页数：9

共 8 条

[1] Temporal Trends in Percutaneous Coronary Intervention Appropriateness Insights From the Clinical Outcomes Assessment Program [J].

Bradley, Steven M. ;

Bohn, Chad M. ;

Malenka, David J. ;

Graham, Michelle M. ;

Bryson, Chris L. ;

McCabe, James M. ;

Curtis, Jeptha P. ;

Lambert-Kerzner, Anne ;

Maynard, Charles .

CIRCULATION, 2015, 132 (01) :20-26

[2] Appropriateness of Percutaneous Coronary Interventions in Washington State [J].

Bradley, Steven M. ;

Maynard, Charles ;

Bryson, Chris L. .

CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES, 2012, 5 (04) :445-453

[3] Appropriateness of Percutaneous Coronary Intervention [J].

Chan, Paul S. ;

Patel, Manesh R. ;

Klein, Lloyd W. ;

Krone, Ronald J. ;

Dehmer, Gregory J. ;

Kennedy, Kevin ;

Nallamothu, Brahmajee K. ;

Weaver, W. Douglas ;

Masoudi, Frederick A. ;

Rumsfeld, John S. ;

Brindis, Ralph G. ;

Spertus, John A. .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2011, 306 (01) :53-61

[4] Appropriate Use Criteria for Coronary Revascularization and Trends in Utilization, Patient Selection, and Appropriateness of Percutaneous Coronary Intervention [J].

Desai, Nihar R. ;

Bradley, Steven M. ;

Parzynski, Craig S. ;

Nallamothu, Brahmajee K. ;

Chan, Paul S. ;

Spertus, John A. ;

Patel, Manesh R. ;

Ader, Jeremy ;

Soufer, Aaron ;

Krumholz, Harlan M. ;

Curtis, Jeptha P. .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2015, 314 (19) :2045-2053

[5] Appropriateness of Coronary Revascularization for Patients Without Acute Coronary Syndromes [J].

Hannan, Edward L. ;

Cozzens, Kimberly ;

Samadashvili, Zaza ;

Walford, Gary ;

Jacobs, Alice K. ;

Holmes, David R., Jr. ;

Stamato, Nicholas J. ;

Sharma, Samin ;

Venditti, Ferdinand J. ;

Fergus, Icilma ;

King, Spencer B., III .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2012, 59 (21) :1870-1876

[6]

New York State Department of Health, 2013, NY STAT MED UPD, V29, P4

[7]

Patel Manesh R, 2012, J Am Coll Cardiol, V59, P857, DOI 10.1016/j.jacc.2011.12.001

[8] ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization [J].

Patel, Manesh R. ;

Dehmer, Gregory J. ;

Hirshfeld, John W. ;

Smith, Peter K. ;

Spertus, John A. .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 53 (06) :530-553

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