Online Program

Time is muscle: The quality of percutaneous coronary interventions as described in the national healthcare quality and disparities reports (NHQR/DR) of the Agency for Healthcare Research and Quality (AHRQ)

Wednesday, November 6, 2013 : 12:45 p.m. - 1:00 p.m.

Darryl Gray, MD, ScD, FAHA, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, MD
Background: Timely percutaneous coronary intervention (PCI), including percutaneous transluminal coronary angioplasty (PTCA), preserves heart muscle and improves clinical outcomes following acute coronary events. PCI-related measures were examined as key indicators of cardiac care quality. Methods: This sequential cross-sectional analysis used data from AHRQ's Congressionally-mandated NHQR/DR, including process measure data from Medicare's Quality Improvement Organization (QIO) Program. For sample all-payer/all-age discharges, QIO data include PCI initiation within 90 minutes of hospital arrival for patients with ST-elevation myocardial infarction or new Left Bundle Branch Block. The NHDR also uses “disparities files” from AHRQ's Healthcare Cost and Utilization Project that include discharge data (from states comprising 63-83% of the 2005-2009 US population) with fairly complete race/ethnicity coding. For patients not transferred to other hospitals, the disparities file captures inpatient PTCA mortality for 40+ year olds, adjusted for age, gender and mortality risk (based on All Patient Refined Diagnostic Related Groups). Results: Overall proportions (standard errors) of PCIs started within 90 minutes rose from 42.1% (0.2%) in 2005 to 91.1% (0.1%) in 2010. Ranges for individual States rose from 19.4% (1.9%) to 71.3% (1.6%) in 2005 to 37.1% (5.8%) to 97.5% (1.2%) in 2010. Figures for men rose from 44.4% (0.3%) to 92.0% (0.1%); those for women rose from 38.3% (0.4%) to 88.6% (0.2%). Rates rose from 43.4% (0.2%) to 91.7% (0.1%) for whites, from 29.1% (0.7%) to 88.3% (0.5%) for blacks, from 33.8% (0.8%) to 89.0% (0.5%) for Hispanics, from 39.6% (1.7%) to 91.3% (0.8%) for Asians and from 43.2% (4.6%) to 89.8% (2.4%) for Native Americans. Overall adjusted mortality fell from 15.8 (0.1) inpatient deaths/1,000 PTCA cases in 2005 to 12.7 (0.1) in 2009 (2010 data pending). Men's rates fell from 13.7 (0.2)/1,000 to 11.2 (0.1); women's rates fell from 20.3 (0.3) to 16.2 (0.2). Rates fell from 15.7 (0.1) to 12.6 (0.1) for non-Hispanic whites, from 16.2 (0.5) to 12.3 (0.4) for blacks, from 17.5 (0.9) to 13.5 (0.8) for Asians/Pacific Islanders and from 16.6 (0.5) to 14.5 (0.5) for Hispanics of all races. Conclusions: Timely PCI rates more than doubled overall and in all population subgroups, presumably at least partially due to various regional/nationwide initiatives. The variability of results still seen (especially across States) identifies successes along with potential opportunities for improvement in this important measure. More modest overlapping drops (~20%) in inpatient PTCA mortality seen in various subgroups studied in larger datasets have multiple causes but are still encouraging.

Learning Areas:

Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public

Learning Objectives:
Identify two measures used in the NHQR/DR to monitor the quality of cardiac procedure care Describe overall nationwide and demographic subgroup trends in the timeliness of percutaneous coronary interventions performed for two types of acute cardiac events in the United States Describe overall nationwide and demographic subgroup trends in inpatient mortality following one type of percutaneous coronary intervention performed in the United States

Keyword(s): Health Care Quality, Heart Disease

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a clinical epidemiologist/health services reesearcher and have been a member of the AHRQ team that generates National Healthcare Quality and Disparities Reports since 2004. I am also a Fellow of the American Heart Association (AHA) and serve as AHRQ's liaison to the Steering Committee of AHA's Quality of Care and Outcome Research Council.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.