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Changes in Percutaneous Coronary Interventions Deemed "Inappropriate" by Appropriate Use Criteria.

Changes in Percutaneous Coronary Interventions Deemed "Inappropriate" by Appropriate Use Criteria.
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Hannan EL, Samadashvili Z, Cozzens K, Gesten F, Osinaga A, Fish DG, Donahue CL, Bass RJ, Walford G, Jacobs AK, Venditti FJ, Stamato NJ, Berger PB, Sharma S, King SB,


Hannan EL, Samadashvili Z, Cozzens K, Gesten F, Osinaga A, Fish DG, Donahue CL, Bass RJ, Walford G, Jacobs AK, Venditti FJ, Stamato NJ, Berger PB, Sharma S, King SB, (click to view)

Hannan EL, Samadashvili Z, Cozzens K, Gesten F, Osinaga A, Fish DG, Donahue CL, Bass RJ, Walford G, Jacobs AK, Venditti FJ, Stamato NJ, Berger PB, Sharma S, King SB,

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Journal of the American College of Cardiology 69(10) 1234-1242 pii S0735-1097(17)30177-8
Abstract
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.

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