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New York State Department of Health December 2010 - page 10 / 62

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In total, 419 cases with cardiogenic shock were removed from 2006-2008 data. is accounts for 0.25 percent of all PCI cases in the three years.

In addition, 140 records from the 2007 and 2008 databases were excluded because they belong to patients residing outside the United States, and these patients could not be followed after hospital discharge. One record belonging to a patient enrolled in a clinical trial (PARTNER) comparing outcomes for two kinds of valve replacement procedures was excluded as well.

Prior to regulatory changes in 2009, PCI in NYS was generally limited to centers with cardiac surgery on-site. However, beginning in 2000, a process was in place to allow time-limited waivers to this policy for centers participating in a special study for heart attack patients. After extensive training and review, hospitals meeting specific conditions were allowed to perform PCI on patients with an ST segment elevation myocardial infarction (a specific kind of heart attack also known as STEMI). In the time period on which this report is based, 14 hospitals were performing Primary PCI without cardiac surgery on-site. Beginning in 2006, seven of those centers were also granted permission to perform PCI on patients not having a STEMI. All hospitals currently performing Primary and/or Elective PCI without cardiac surgery on-site are listed on the final page of this report.

RISK ADJUSTMENT FOR ASSESSINg PROVIDER PERFORMANCE

Hospital or physician performance is an important factor that directly relates to patient outcomes. Whether patients recover quickly, experience complications or die following a procedure is in part a result of the kind of medical care they receive. It is difficult, however, to compare outcomes among hospitals when assessing performance because different hospitals treat different types of patients. Hospitals with sicker patients may have higher rates of complications and death than other hospitals in the state. e following describes how the Department of Health adjusts for patient risk in assessing outcomes of care in different hospitals.

Data Collection, Data Validation and Identifying In-Hospital/30-Day Deaths

As part of the risk-adjustment process, hospitals in NYS where PCI is performed provide information to the Department of Health for each patient undergoing those procedures. Data concerning patients’ demographic and clinical characteristics are collected by hospitals’ cardiac catheterization laboratories. Approximately 40 of these characteristics (risk factors) are collected for each patient. Along with information about the hospital, physician and the patient’s status at discharge, these data are entered into a computer and sent to the Department of Health for analysis.

Data are verified through review of unusual reporting frequencies, cross-matching of PCI data with other Department of Health databases and a review of medical records for a selected sample of cases. ese activities are extremely helpful in ensuring consistent interpretation of data elements across hospitals.

  • e analysis bases mortality on deaths occurring during the same hospital stay in which a patient underwent PCI and

on deaths that occur after hospital discharge but within 30 days of PCI. In this report, an in-hospital death is defined as a patient who died subsequent to PCI during the same acute care admission or was discharged to hospice care and expired within 30 days. Data on deaths occurring after discharge from the hospital are made available by the Department of Health and its Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene and the Social Security Administration.

Assessing Patient Risk

Each person who develops coronary artery disease has a unique health history. A cardiac profile system has been developed to evaluate the risk of treatment for each individual patient based on his or her history, weighing the important health facts for that person based on the experiences of thousands of patients who have undergone the same procedures in recent years. All important risk factors for each patient are combined to create his or her risk profile. For example, an 80-year-old patient with a heart attack in the past six hours has a very different risk profile than a 40-year-old who has never suffered a heart attack.

  • e statistical analyses conducted by the Department of Health consist of determining which of the risk factors collected

are significantly related to in-hospital/30-day death and determining how to weight the significant risk factors to predict the chance each patient will have of dying in the hospital or after discharge but within 30 days of PCI, given his or her specific characteristics.

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