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)

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.