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Data comparison could improve mortality outcomes in carotid artery stenting
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Comparing mortality outcomes as part of the recertification process for health systems with carotid artery stenting programs may improve mortality rates in those programs, according to findings published recently.
Hospitals performing carotid artery stenting are required by CMS to conduct a quality assurance recertification process every 2 years. However, protocols for recertification do not include comparisons of post-procedural mortality rates between participating hospitals. The researchers suggested that hospitals performing poorly in comparison with other hospitals may not be identified by the current procedures.
The aim of the present retrospective cohort study of Medicare beneficiaries was to identify hospitals with statistically increased mortality rates in the post-procedure setting. This was achieved by comparing risk-standardized procedural outcomes in hospitals in the United States.
Patients who underwent carotid artery stenting between July 2009 and June 2011 at 927 US hospitals underwent analysis, which included claims from 22,708 patients. The researchers used the Hospital Compare statistical method to determine patient- and hospital-level predictors of mortality.
The reported crude 30-day mortality rate was 2%. Variation between 1.1% and 5.1% was reported for risk-standardized 30-day mortality rates after stenting (P<.001 for the difference).
Mortality rates that were statistically higher than the national mean were reported in 13 hospitals in the cohort (P<.05). Five hospitals had rates that were lower than the national mean (P<.05).
“When combined with information currently used by Medicare for [carotid artery stenting] recertification, such as clinical registry data and program reports, clinical outcomes comparisons could enhance Medicare’s ability to identify hospitals that are questionable candidates for recertification,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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