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Outcomes Reporting May Make Physicians Risk-Averse

Study analyzes reporting deaths after percutaneous coronary intervention

TUESDAY, Mar. 3 (HealthDay News) -- Although clinical outcomes report cards perform a valuable public health purpose, the experience of publicly reporting death rates after percutaneous coronary intervention (PCI) in two states suggests that doctors may become risk-averse and avoid high-risk patients, according to a review in the Mar. 10 issue of the Journal of the American College of Cardiology.

Frederic S. Resnic, M.D., and Frederick G.P. Welt, M.D., reviewed the experience of Massachusetts after instituting a policy in 2003 requiring reporting of every PCI procedure performed, only second behind New York, which instituted its policy in 1997.

The researchers note that although New York has seen a 36 percent reduction in mortality after PCI from 1997 to 2003, this could be attributed to many factors. In Massachusetts, they found that there has been a 43 percent decline in patients undergoing PCI for cardiogenic shock from 2003 to 2005, with a similar 30 percent decline in New York from 1997 to 2003. Because the policy considers only in-hospital mortality as an outcome, the authors suggest that physicians have become risk-averse and less willing to perform procedures on high-risk patients who would significantly benefit from them. They propose several strategies that could improve public reporting of outcomes.

"In summary, Resnic and Welt have done all of us in the cardiology community a favor by 'singing' about the problems with the application of PCI mortality risk scores to assess comparative quality," Robert M. Califf, M.D., and Eric D. Peterson, M.D., from Duke University Medical Center in Durham, N.C., write in an accompanying editorial. "As with any quality tool, the value of the measurement will be determined by the wisdom of those who use it."

Several study authors have disclosed relationships with Medtronic and Abbott Vascular, both involved in products related to PCI.

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