Online Program

Time is muscle: The Quality of Percutaneous Coronary Interventions as Described in the National Healthcare Quality and Disparities Report (NHQR/DR) of the Agency for Healthcare Research and Quality (AHRQ)

Monday, November 2, 2015

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), which generally involves percutaneous transluminal coronary angioplasty (PTCA), is a process measure of cardiac care quality.

Methods: For sample all-payer adult discharges meeting specific criteria, Medicare’s Quality Improvement Organization (QIO) Program measures PCI initiation within 90 minutes of hospital arrival.  For 40+ year-old (YO) patients meeting specific criteria, outcome data on nationwide inpatient PTCA mortality (adjusted for age, gender and mortality risk) came from AHRQ’s Healthcare Cost and Utilization Project.

Results:  For <65 YOs, proportions (standard errors) of PCIs started within 90 minutes rose from 44.9% (0.3%) in 2005 to 95.4% (0.1%) in 2012.  Proportions for 65-74 YOs rose from 40.4% (0.5%) to 95.2% (0.2%). Proportions for 75-84 YOs rose from 35.3% (0.6%) to 93.8% (0.2%).   Those for 85+ YOs rose from 29.2% (1.0%) to 93.8% (0.4%).  For 40-64 YOs, adjusted mortality fell from 12.1 (0.2) inpatient deaths/1,000 PTCA cases in 2005 to 11.7 (0.2) in 2012. Rates for 65-69 YOs fell from 16.1 (0.4)/1,000 to 14.4 (0.3)/1,000.  Rates for 70-74 YOs fell from 22.8 (0.3)/1,000 to 15.6 (0.4)/1,000.  Rates for 75-79 YOs fell from 30.1 (0.6)/1,000 to 20.5 (0.5)/1,000.  Rates for 80-84 YOs fell from 39.2 (0.6)/1,000 to 27.4 (0.7)/1,000. Rates for 85+ YOs fell from 59.0 (0.4)/1,000 to 40.5 (1.0)/1,000.  

Conclusions:  Considerable increases in PCI timeliness virtually eliminated disparities initially seen in older patients.  Ongoing initiatives might consider even shorter target time intervals.  Complementary modest declines in inpatient PTCA mortality (especially in older patients) may  have multiple causes but are still encouraging.

Learning Areas:

Chronic disease management and prevention
Clinical medicine applied in public health
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 Compare agegroup-specific trends in the United States in the timeliness of inpatient percutaneous coronary interventions performed for acute coronary syndromes. Compare agegroup-specific U.S. trends in inpatient mortality following inpatient percutaneous transluminal coronary angioplasty

Keyword(s): Quality of Care, Heart Disease

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract author on the content I am responsible for because: I am a clinical epidemiologist/health services researcher and am a member of the AHRQ team that generates National Healthcare Quality and Disparities Reports. I am also a Fellow of the American College of Cardiology and of the American Heart Association.
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.