Doctors implant fewer stents in states that report outcomes Researchers: Physicians in reporting states may scrutinize PCI appropriateness

Acute myocardial infarction (AMI) patients are 18% less likely to receive percutaneous coronary interventions (PCIs) in states that require hospitals to publically report the procedure's outcomes, according to a new study in JAMA.

For the study, Harvard School of Public Health researchers reviewed Medicare data on about 100,000 patients hospitalized for an AMI in the three U.S. states that require outcome reporting for PCIs—Pennsylvania, New York, and Massachusetts—and in seven nearby states that do not require reporting.

They found that more than 37% of hospitalized AMI patients in reporting states received PCIs, compared to nearly 43% in non-reporting states. However, overall mortality rates for AMI patients were the same in reporting and non-reporting states.

The study authors say they could not conclusively determine why physicians performed fewer PCIs in reporting states.

They suggest that public reporting may encourage them to examine patients more closely to determine whether PCIs are appropriate. "Alternatively, public reporting may have led clinicians to avoid PCI on eligible patients because of concern over the risk of poor outcomes," the study says.

Researchers take a closer look: Massachusetts PCI rates drop from 2005 to 2010 As part of the study, researchers examined PCI rates in Massachusetts from 2002 to 2004 and from 2005 to 2010. The state implemented public reporting for PCIs in 2005.

Before the reporting law was implemented, the state had similar PCI procedure rates as non-reporting states in 2010. After 2005, Massachusetts PCI rates dropped.

"There are a lot of states that are moving forward with public reporting, and I think transparency and accountability are not going away," lead author Karen Joynt says, adding, "Our hope is that this brings up a lot of questions" (McKinney, Modern Healthcare, 10/9 [subscription required]; Seaman, Reuters, 10/9; Phend, MedPage Today, 10/9).