PCI Outcomes in U.S. Hospitals with Varying Structural Characteristics: Analysis of the NCDR ® CathPCI Registry ® Peter Cram, MD, MBA 1,2 , John A. House, MS 3 , John Messenger, MD 4 , Robert N. Piana, MD 5 , Phillip A Horwitz, MD 6 , and John A. Spertus, MD, MPH 3,7 1 Division of General Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 2 Iowa City Veterans Administration Medical Center, Iowa City, IA 3 St. Luke's Mid America Heart Institute, Kansas City, MO 4 Division of Cardiology, University of Colorado Denver School of Medicine, Aurora, CO 5 Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN 6 Division of Cardiology, University of Iowa Carver College of Medicine, Iowa City, IA 7 The University of Missouri at Kansas City, Kansas City, MO Abstract Background—In the U.S. there continues to be debate about whether certain types of hospitals deliver improved patient outcomes. We sought to assess the association between hospital organizational characteristics and in-hospital outcomes for percutaneous coronary intervention (PCI). Methods—Retrospective analysis of 2004-2007 data for 694 U.S. hospitals participating in the American College of Cardiology NCDR ® CathPCI Registry ® . Our analysis focused on 1,113,554 patients who underwent PCI in 471 not-for-profit (NFP) hospitals, 131 major teaching hospitals, 79 for-profit (FP) hospitals, and 13 physician-owned specialty hospitals. Outcomes included in- hospital mortality, stroke, bleeding, vascular injury and a composite representing one or more of the individual complications. We used the current NCDR mortality risk model to calculate risk standardized mortality ratios (RSMR) for each category of hospital and compared hospital groupings for all patients in aggregate and in subgroups stratified by patients' indications for PCI. Results—Patients treated in major teaching hospitals were younger, while FP hospitals performed greater proportion of PCI for patients with ST-elevation myocardial infarction (STEMI) (P<.0001). Specialty hospitals treated patients with less acuity including a lower proportion of patients with STEMI. In unadjusted analyses, specialty hospitals had significantly lower rates of all adverse outcomes compared to NFP, teaching, and FP hospitals including in-hospital mortality (0.7%, 1.2%, 1.4%, and 1.4% respectively; P<.001) and the composite endpoint (2.4%, 4.1%, 4.6%, 4.3%; P<.001). In adjusted analyses, RSMR was significantly lower for specialty hospitals Corresponding Author: Peter Cram, MD MBA, Division of General Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 6GH SE, Iowa City, IA 52246, 319-356-4241 (ph), 319-887-4932 (fax), peter-cram@uiowa.edu. Competing Interests: This work is funded by R01 HL085347-01A1 from NHLBI at the NIH. Dr. Cram is also supported in part by the Department of Veterans Affairs. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. Dr. Cram has received payment for advising Vanguard Health- an operator of for-profit hospitals- on quality improvement efforts. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author Manuscript Am Heart J. Author manuscript; available in PMC 2013 February 1. Published in final edited form as: Am Heart J. 2012 February ; 163(2): 222–229.e1. doi:10.1016/j.ahj.2011.10.010. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript