Abstract
Limited data exist regarding the characteristics of hospitals that do and do not participate in voluntary public reporting programs. To describe hospital characteristics and trends associated with early participation in the American College of Cardiology (ACC) voluntary reporting program for cardiac catheterization-percutaneous coronary intervention (CathPCI) and implantable cardioverter-defibrillator (ICD) registries. This cross-sectional study analyzed enrollment trends and characteristics of hospitals that did and did not participate in the ACC voluntary public reporting program. All hospitals reporting procedure data to the National Cardiovascular Data Registry (NCDR) CathPCI or ICD registries that were eligible for the public reporting program from July 2014 (ie, program launch date) to May 2017 were included. Stepwise logistic regression was used to identify hospital characteristics associated with voluntary participation. Enrollment trends were evaluated considering the date US News & World Report (USNWR) announced that it would credit participating hospitals. Data analysis was performed from March 2017 to January 2018. Hospital characteristics and participation in the public reporting program. By May 2017, 561 of 1747 eligible hospitals (32.1%) had opted to participate in the program. Enrollment increased from 240 to 376 hospitals (56.7%) 1 month after the USNWR announcement that program participation would be considered as a component of national hospital rankings. Compared with hospitals that did not enroll, program participants had increased median (IQR) procedural volumes for PCI (481 [280-764] procedures vs 332 [186-569] procedures; P < .001) and ICD (114 [56-220] procedures vs 62 [25-124] procedures; P < .001). Compared with nonparticipating hospitals, an increased mean (SD) proportion of participating hospitals adhered to composite discharge medications after PCI (0.96 [0.03] vs 0.92 [0.07]; P < .001) and ICD (0.88 [0.10] vs 0.81 [0.12]; P < .001). Hospital factors associated with enrollment included participation in 5 or more NCDR registries (odds ratio [OR],1.98; 95% CI, 1.24-3.19; P = .005), membership in a larger hospital system (ie, 3-20 hospitals vs ≤2 hospitals in the system: OR, 2.29; 95% CI, 1.65-3.17; P = .001), participation in an NCDR pilot public reporting program of PCI 30-day readmissions (OR, 2.93; 95% CI, 2.19-3.91; P < .001), university affiliation (vs government affiliation: OR, 3.85, 95% CI, 1.03-14.29; P = .045; vs private affiliation: OR, 2.22; 95% CI, 1.35-3.57; P < .001), Midwest location (vs South: OR, 1.47; 95% CI, 1.06-2.08; P = .02), and increased comprehensive quality ranking (4 vs 1-2 performance stars in CathPCI: OR, 8.08; 95% CI, 5.07-12.87; P < .001; 4 vs 1 performance star in ICD: OR, 2.26; 95% CI, 1.48-3.44; P < .001) (C statistic = 0.829). This study found that one-third of eligible hospitals participated in the ACC voluntary public reporting program and that enrollment increased after the announcement that program participation would be considered by USNWR for hospital rankings. Several hospital characteristics, experience with public reporting, and quality of care were associated with increased odds of participation.
Highlights
This study found that one-third of eligible hospitals participated in the American College of Cardiology (ACC) voluntary public reporting program and that enrollment increased after the announcement that program participation would be considered by US News & World Report (USNWR) for hospital rankings
To be eligible for the public reporting program, hospitals must meet a minimum for number of procedures (25 procedures annually for the catheterization-percutaneous coronary intervention (CathPCI) Registry and 11 procedures annually for the implantable cardioverter-defibrillator (ICD) Registry) and must have at least 9 months of data submitted to the registry
For evaluation of hospital characteristics, we limited our analysis to hospitals eligible for public reporting from 2014 to 2016 and compared those that participated in the voluntary public reporting program for CathPCI or ICD registries with those that did not enroll in either registry
Summary
Public reporting is intended to promote health care quality and transparency by providing consumers, payers, and clinicians and health care institutions access to information on hospital performance. Public reporting initiatives have proliferated, with the development of several national and state programs, as well as numerous efforts from payers, business consumer groups, and independent organizations. Many public reporting programs rely on administrative data, which limits clinical validity. Other programs report data generated with proprietary methods that are not disclosed. In comparison, clinical registry data are infrequently used for public reporting owing to the effort required to collect data; these data consider the nuances associated with delivering guideline-concordant care.9Recognizing the barriers to clinically valid and meaningful reporting, the American College of Cardiology (ACC) initiated a voluntary public reporting program in 2014 from the NCDR (National Cardiovascular Data Registry) cardiac catheterization-percutaneous coronary intervention (CathPCI) and implantable cardioverter-defibrillator (ICD) registries. Public reporting is intended to promote health care quality and transparency by providing consumers, payers, and clinicians and health care institutions access to information on hospital performance.. Public reporting initiatives have proliferated, with the development of several national and state programs, as well as numerous efforts from payers, business consumer groups, and independent organizations.. Many public reporting programs rely on administrative data, which limits clinical validity.. Recognizing the barriers to clinically valid and meaningful reporting, the American College of Cardiology (ACC) initiated a voluntary public reporting program in 2014 from the NCDR (National Cardiovascular Data Registry) cardiac catheterization-percutaneous coronary intervention (CathPCI) and implantable cardioverter-defibrillator (ICD) registries. The advantages associated with the ACC’s public reporting program are that it uses robust and accurate clinical data, calculates performance using a transparent methodology, and is continuously subject to improvement and oversight.. Hospitals could receive up to 3 percentage points by participating in public reporting programs maintained by the ACC and Society of Thoracic Surgeons (STS).
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