经适当使用标准判定为“不适当”的经皮冠状动脉介入治疗的变化。
Changes in Percutaneous Coronary Interventions Deemed "Inappropriate" by Appropriate Use Criteria.
机构信息
Department of Health Policy, Management and Behavior, University at Albany, State University of New York, Albany, New York.
Department of Health Policy, Management and Behavior, University at Albany, State University of New York, Albany, New York.
出版信息
J Am Coll Cardiol. 2017 Mar 14;69(10):1234-1242. doi: 10.1016/j.jacc.2016.12.025.
BACKGROUND
Recent studies have demonstrated relatively high rates of percutaneous coronary interventions (PCIs) classified as "inappropriate." The New York State Department of Health shared rates with hospitals and announced the intention of withholding reimbursement pending demonstration of clinical rationale for Medicaid patients with inappropriate PCIs.
OBJECTIVES
The objective was to examine changes over time in the number and rate of inappropriate PCIs.
METHODS
Appropriate use criteria were applied to PCIs performed in New York in patients without acute coronary syndromes or previous coronary artery bypass graft surgery in periods before (2010 through 2011) and after (2012 through 2014) efforts were made to decrease inappropriateness rates. Changes in the number of appropriate PCIs were also assessed.
RESULTS
The percentage of inappropriate PCIs for all patients dropped from 18.2% in 2010 to 10.6% in 2014 (from 15.3% to 6.8% for Medicaid patients, and from 18.6% to 11.2% for other patients). The total number of PCIs in patients with no acute coronary syndrome/no prior coronary artery bypass graft surgery that were rated as inappropriate decreased from 2,956 patients in 2010 to 911 patients in 2014, a reduction of 69%. For Medicaid patients, the decrease was from 340 patients to 84 patients, a decrease of 75%. For a select set of higher-risk scenarios, there were higher numbers of appropriate PCIs per year in the period from 2012 to 2014.
CONCLUSIONS
The inappropriateness rate for PCIs and the use of PCI for elective procedures in New York has decreased substantially between 2010 and 2014. This decrease has occurred for a large proportion of PCI hospitals.
背景
最近的研究表明，经皮冠状动脉介入治疗（PCI）的分类中存在相对较高的不适当率。纽约州卫生部与医院分享了这一比率，并宣布打算在证明对医疗补助计划中接受不适当 PCI 的患者具有临床合理性之前，暂停报销。
目的
本研究旨在考察一段时间内不适当 PCI 的数量和比率的变化。
方法
在努力降低不适当率之前（2010 年至 2011 年）和之后（2012 年至 2014 年），对在纽约进行的无急性冠状动脉综合征或先前冠状动脉旁路移植术的患者的 PCI 应用适宜性使用标准，评估适当 PCI 的数量变化。
结果
所有患者的不适当 PCI 比例从 2010 年的 18.2%降至 2014 年的 10.6%（医疗补助患者从 15.3%降至 6.8%，其他患者从 18.6%降至 11.2%）。无急性冠状动脉综合征/无先前冠状动脉旁路移植术且被评为不适当的 PCI 总数从 2010 年的 2956 例降至 2014 年的 911 例，减少了 69%。对于医疗补助患者，从 340 例降至 84 例，减少了 75%。对于一组较高风险的情况，在 2012 年至 2014 年期间，每年的适当 PCI 数量更多。
结论
2010 年至 2014 年期间，纽约 PCI 的不适当率和选择性 PCI 的使用率大幅下降。这一减少发生在很大一部分 PCI 医院。
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