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Research Letter |

Patterns of Institutional Review of Percutaneous Coronary Intervention Appropriateness and the Effect on Quality of Care and Clinical Outcomes

Nihar R. Desai, MD, MPH1,2; Craig S. Parzynski, MS2; Harlan M. Krumholz, MD, SM1,2; Karl E. Minges, MPH2; John C. Messenger, MD3; Brahmajee K. Nallamothu, MD, MPH4,5; Jeptha P. Curtis, MD1,2
[+] Author Affiliations
1Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
2Center for Outcomes Research and Evaluation, Yale–New Haven Health Services Corporation, New Haven, Connecticut
3Division of Cardiology, University of Colorado School of Medicine, Aurora
4Division of Cardiovascular Diseases, University of Michigan, Ann Arbor
5Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
JAMA Intern Med. 2015;175(12):1988-1990. doi:10.1001/jamainternmed.2015.6217.
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This Research Letter reports heterogeneity in institutional review of percutaneous coronary intervention appropriateness and calls for the identification of effective strategies to improve institutional review.

More than 600 000 percutaneous coronary interventions (PCIs) are performed each year, accounting for more than $12 billion in health care spending.1 In 2009, the American College of Cardiology, American Heart Association, and several other professional organizations released appropriate use criteria (AUC) for coronary revascularization2 designed to support better selection of patients for PCI. Prior studies1,3,4 suggest that as many as 1 in 6 nonacute PCIs may be inappropriate (rarely appropriate). Although the AUC have received substantial attention, little is known about how institutions have responded to them, specifically whether they have developed mechanisms for internal review of PCI appropriateness. Furthermore, whether these review practices are associated with differences in procedural appropriateness, quality of care, and patient outcomes remains uncertain.

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Figure.
Proportion of Nonacute PCIs Classified as Rarely Appropriate

A, Hospital variation in the proportion of rarely appropriate PCIs stratified by review strategy. Each point represents the proportion of rarely appropriate PCIs performed at an individual hospital. The horizontal line represents the median of hospitals, and the bottom and top lines of the rectangle represent the 25th and 75th percentiles.

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