Author + information
- Received September 23, 2016
- Revision received November 30, 2016
- Accepted December 8, 2016
- Published online March 6, 2017.
- Edward L. Hannan, PhDa,∗ (, )
- Zaza Samadashvili, MDa,
- Kimberly Cozzens, MAa,
- Foster Gesten, MDb,
- Alda Osinaga, MDc,
- Douglas G. Fish, MDc,
- Constance L. Donahue, AuDc,
- Ronald J. Bass, BAc,
- Gary Walford, MDd,
- Alice K. Jacobs, MDe,
- Ferdinand J. Venditti, MDf,
- Nicholas J. Stamato, MDg,
- Peter B. Berger, MDh,
- Samin Sharma, MDi and
- Spencer B. King III, MDj
- aDepartment of Health Policy, Management and Behavior, University at Albany, State University of New York, Albany, New York
- bOffice of Quality and Patient Safety, New York State Department of Health, Albany, New York
- cOffice of Health Insurance Programs, New York State Department of Health, Albany, New York
- dHeart and Vascular Institute, Johns Hopkins University, Baltimore, Maryland
- eDepartment of Cardiology, Boston Medical Center, Boston, Massachusetts
- fDepartment of Cardiology, Albany Medical Center, Albany, New York
- gDepartment of Cardiology, Campbell County Memorial Hospital, Gillette, Wyoming
- hDepartment of Cardiology, Northwell Health, Great Neck, New York
- iClinical Cardiology, Mt. Sinai Medical Center, New York, New York
- jAcademic Affairs, St. Joseph’s Health System, Atlanta, Georgia
- ↵∗Address for correspondence:
Dr. Edward L. Hannan, School of Public Health, State University of New York, University at Albany, One University Place, Rensselaer, New York 12144-3456.
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.
- Percutaneous Coronary Interventions Reporting System
- stable coronary artery disease
Dr. Jacobs is the site principal investigator on research grants from Abbott Vascular, Boston Scientific Corporation, Bristol-Myers Squibb/Sanofi, Cordis Corporation, Eli Lilly/Daiichi-Sankyo, and Medtronic Vascular. Dr. Sharma is a member of the speakers bureaus of Abbott, Boston Scientific Corporation, Cardiovascular System Incorporated, Abiomed, Trireme, and The Medicines Company. Dr. King is a member of the data safety monitoring boards for Harvard Clinical Research Institute, Duke University, Capicor, Inc., Merck & Company, and Stentys. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Frederick A. Masoudi, MD, served as Guest Editor for this paper.
- Received September 23, 2016.
- Revision received November 30, 2016.
- Accepted December 8, 2016.
- American College of Cardiology Foundation