与冠状动脉介入治疗中风险调整后结果的公开报告相关的风险规避对公共卫生的危害。
The public health hazards of risk avoidance associated with public reporting of risk-adjusted outcomes in coronary intervention.
作者信息
Resnic Frederic S, Welt Frederick G P
机构信息
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
J Am Coll Cardiol. 2009 Mar 10;53(10):825-30. doi: 10.1016/j.jacc.2008.11.034.
Abstract
Public reporting of risk-adjusted outcomes for percutaneous coronary intervention (PCI) procedures has been mandated in New York State for more than a decade. During that time there has been a significant decline in the unadjusted mortality after such procedures. Massachusetts joined New York in 2003 as only the second state to require case level reporting of every coronary interventional procedure performed. In this review, we explore the differences in the populations reported by the 2 states and consider possible risks of public reporting of clinical outcomes after PCI procedures, including the risk of increasing conservatism in the treatment of the sickest patients. We offer a conceptual framework to understand the potential risk-averse behavior of interventional cardiologists subject to public reporting, and offer several proposals to counteract this potential deleterious effect of reporting programs.
摘要
在纽约州，对经皮冠状动脉介入治疗（PCI）手术的风险调整后结果进行公开报告已强制执行了十多年。在此期间，此类手术后未经调整的死亡率大幅下降。马萨诸塞州于2003年加入纽约州，成为仅有的第二个要求对每例进行的冠状动脉介入手术进行病例层面报告的州。在本综述中，我们探讨了这两个州所报告人群的差异，并考虑了PCI手术后临床结果公开报告可能存在的风险，包括对病情最严重患者治疗中增加保守性的风险。我们提供了一个概念框架来理解接受公开报告的介入心脏病专家潜在的规避风险行为，并提出了几项建议以抵消报告计划的这种潜在有害影响。
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