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New York State Department of Health December 2010 - page 12 / 62

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2008 HOSPITAL RISK-ADJUSTED MORTALITY FOR PCI

Table 1 and Figures 1 and 2 present the PCI mortality results for the 54 hospitals performing PCI in NYS in 2008. e table contains, for each hospital, the number of PCIs resulting in 2008 discharges, the number of in-hospital/ 30-day deaths, the OMR, the EMR based on the statistical model presented in Appendix 1, the RAMR and a 95 percent confidence interval for the RAMR. It also contains each hospital’s volume of cases and RAMR for non-emergency patients. Emergency patients are defined to be patients in a state of hemodynamic instability (very low blood pressure), or patients who experienced a heart attack within 24 hours prior to undergoing PCI. e hospital RAMRs for non-emergency PCI patients are provided because many studies are confined to this group of patients and because these patients comprise the majority of all PCI patients (87.12 percent in 2008).

  • e overall in-hospital/30-day OMR for the 54,990 PCIs included in this report was 0.95 percent. Observed mortality

rates ranged from 0.00 percent to 8.16 percent. e range in EMRs, which measure patient severity of illness, was between 0.50 percent and 3.79 percent. It should be noted that during the time period covered in this report, the hospitals with the highest OMR and EMR values were approved to perform only Primary PCI. is means that all cases reported for these centers were emergency cases. e RAMRs, which measure hospital performance, range from 0.00 percent to 4.45 percent. Based on condence intervals for RAMRs, three hospitals (Brookdale Hospital Medical Center in Brooklyn, Good Samaritan Hospital in Suern and University Hospital of Brooklyn) had RAMRs that were signicantly higher than the statewide average. Two hospitals (Long Island Jewish Medical Center in New Hyde Park and Mount Sinai Hospital in Manhattan) had RAMRs that were signicantly lower than the statewide average.

  • e last column of Table 1 presents the hospital RAMRs for non-emergency cases (based on the statistical model

presented in Appendix 2). As presented in the last row, the statewide in-hospital/30-day mortality rate for non-emergency cases is 0.62 percent. e range of RAMRs was from 0.00 percent to 2.14 percent. Four hospitals (Crouse Hospital in Syracuse, NY Hospital Center – ueens, St. Peter’s Hospital in Albany and University Hospital of Brooklyn) had RAMRs that were signicantly higher than the statewide rate. One hospital (Long Island Jewish Medical Center in New Hyde Park) had an RAMR that was signicantly lower than the statewide rate.

Figures 1 and 2 provide a visual representation of the data displayed in Table 1. For each hospital, the black dot represents the RAMR and the gray bar represents the confidence interval, or potential statistical error, for the RAMR. e black vertical line is the NYS in-hospital/30-day mortality rate. For any hospital where the gray bar crosses the statewide average line, the RAMR is not statistically different from the state as a whole. Hospitals that are statistical outliers will have gray bars (confidence intervals) that are either entirely above or entirely below the line for the statewide rate.

Since the 2008 PCI analysis is based on in-hospital/30-day mortality and excludes shock cases, the associated mortality rates cannot be compared directly to some previous NYS publications which are based on only in-hospital mortality and include shock cases.

  • e observed in-hospital mortality rate (not shown in Table 1) for 2008 PCI discharges was 0.57 percent for the 54,990

patients included in Table 1. For the non-emergency analysis, there were 47,909 patients with an in-hospital mortality rate of 0.28 percent.

2006-2008 HOSPITAL DATA FOR PCI

Table 2 provides the number of PCIs, the in-hospital/30-day OMR and RAMR for 2006-2008 for each of three types of PCI patients in the 54 hospitals performing PCI during the time period. e three types of patients are: all patients, non-emergency patients and emergency patients (patients in a state of hemodynamic instability, typically associated with very low blood pressure, or patients who experienced a heart attack within 24 hours prior to undergoing PCI). e statistical models that are the basis for all patients, non-emergency patients and emergency patients in 2006-2008 are presented in Appendices 3-5, respectively.

As indicated in Table 2, the three-year observed in-hospital/30-day mortality rates for all PCI patients ranged from 0.00 percent to 11.11 percent, and the RAMRs ranged from 0.00 percent to 2.86 percent. Ten hospitals (Brookdale Hospital Medical Center in Brooklyn, Crouse Hospital in Syracuse, Glens Falls Hospital in Glens Falls, Good Samaritan Hospital in Suern, M I Bassett Hospital in Cooperstown, Monteore Medical Center – Weiler Division in the Bronx, St. Vincent’s Catholic Medical Center in Manhattan, St. Peter’s Hospital in Albany, Strong Memorial Hospital in Rochester and University Hospital of Brooklyn) had RAMRs that were signicantly higher than the statewide rate. ree hospitals (Long

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