October 10, 2012
Public Reporting Affects Rate Of Angioplasty Procedures Following Heart Attacks
Connie K. Ho for redOrbit.com — Your Universe Online
Heart attacks can happen at any moment. They might be triggered by a factor related to diet or exercise, but the question remains as to what happens to patients following treatment.
Recently, researchers from Harvard School of Public Health (HSPH) ventured on a mission to analyze data pooled from 100,000 Medicare patients who had suffered a heart attack and the effects that public reporting might have on percutaneous coronary intervention (PCI) following the heart attack.
With the study, the team of investigators found that the rate was lower for patients who had PCI, a procedure that opens narrowed coronary arteries, in states with public reporting as compared to patients who had PCI but lived in states that did not have public reporting.
"Making performance data available to patients is very important. It helps them choose the best health care," remarked Dr. Karen Joynt, an instructor in the Department of Health Policy and Management at HSPH, in a prepared statement. "However, the results of our study make us wonder if we're doing public reporting as well as we could be."
The researchers also found that, despite the difference in PCIs that were based off of public reporting, the survival rates from the procedures were not affected by the availability of public reporting. The findings were recently published in the Journal of the American Medical Association.
"Public reporting of patient outcomes is a key tool to drive improvements in health care delivery. Over the past 20 years, three states–New York (1991), Pennsylvania (2001), and Massachusetts (2005)–have instituted mandatory public reporting of outcomes for PCI."
"The idea behind public reporting is simple: collecting and publicly reporting performance will enable patients to choose high-quality hospitals and motivate clinicians to improve performance. However, critics worry that public reporting may create disincentives for physicians and hospitals to care for the sickest patients, potentially leading clinicians to avoid offering lifesaving procedures to these patients," noted the authors in the article.
In particular, the scientists looked at data that was recorded in 2002 and 2010 from reporting states (i.e. Massachusetts, New York, and Pennsylvania) and regional non-reporting states (i.e. Connecticut, Delaware, Maine, Maryland, New Hampshire, and Rhode Island).
The authors of the article believe that there are two possible reasons as to why public reporting is related to lower rates of PCI for patients who suffer heart attacks. For one, physicians who thought about the risk of poor outcomes for patients who were already very sick. Secondly, doctors decided to not perform PCIs as they thought that it was unnecessary.
"It will be important for follow-up work to determine why this is going on, and more importantly, how we can address it," continued Joynt in the statement.
The researchers believe that public reporting is becoming more and more popular in the health sector. Many states have voluntarily begun to start reporting programs, while other states are considering the creation of such programs. With the publicizing of hospital performance, patients can utilize the information to choose the best hospital.
"Improving transparency of the health care system is critical," commented Dr. Ashish Jha, an associate professor of health policy and management at HSPH, in the statement. "However, we have to make sure we do it right. Otherwise we risk creating incentives to deny care to the sickest patients."
In an accompanying editorial, Dr. Mauro Moscucci of the University of Miami School of Medicine commented on the impact that the study has on future research.
"Patients are often treated regardless of the perceived futility of the planned intervention. The study by Joynt et al confirms the possible unintended consequences of public reporting, while highlighting its association with (or lack thereof) clinical outcomes. In addition, these findings may help spearhead a new focus on procedures that, while perceived appropriate based on current use criteria, might not result in added benefit in selected patients," explained Moscucci.