Hospitals avoid high-risk procedures to lower publicly reported mortality rates

Outlier hospitals in Massachusetts appear to be avoiding performing a particular type of coronary catheterization on high-risk patients in a successful effort to reduce their publicly reported mortality rates, a study published in the June issue of JACC: Cardiovascular Interventions concludes.

After public reporting began, the four hospitals with higher-than-normal mortality rates--negative outliers--lowered their mortality rates for the 30 days following percutaneous coronary intervention (PCI) by 18 percent compared with nonoutlier hospitals, researchers from Boston's Brigham and Women's Hospital found.

"The risk profile of PCI patients at outlier institutions was significantly lower after public identification compared with nonoutlier institutions, suggesting that risk-aversive behaviors among PCI operators at outlier institutions may be an unintended consequence of public reporting in Massachusetts," the researchers concluded.

Patients with the most to gain thus may be most likely to be denied access to the potentially life-saving intervention, the researchers noted, as reported by MedPage Today.

"The challenges ahead are how best to develop public reporting for a good purpose and yet avoid unintended consequences such as . . . risk-averse behavior," Gregory J. Dehmer, M.D., of Texas A&M University Health Science Center College of Medicine, said in an accompanying commentaryaccording to TCTMD.

The findings follow reports that public reporting of healthcare outcomes is often misunderstood by consumers who don't understand how to interpret the data, such as the difference between the number of deaths and risk-adjusted mortality rates. Up to two-thirds of consumers questioned in one study incorrectly interpreted data about the quality of cardiac surgeons, researchers at Harvard Medical School found.

Another study released last fall in Journal of American Medical Association found states that publicly report PCI outcomes perform fewer of the procedures than states without mandatory public reporting, but found no difference in mortality between states with and without reporting.

To learn more:
- read the study abstract
- here's the commentary (subscription required)
- see the MedPage Today article
- check out the TCTMD article
- read about the Havard study
- here's the JAMA study abstract