Analysis and Comparison of Operator-Specific Outcomes in Interventional Cardiology: From a Multicenter Database of 4860 Quality-Controlled Procedures

Background Medical consumers are increasingly requesting methods to discriminate among the results of different providers. Standards for appropriate modeling, risk adjustment, and evaluation (“scorecarding”) in this setting are not well developed, although such evaluation is being performed by the medical insurance industry and by several states in the United States. Our objectives were to develop and examine clinically meaningful methodology for assessing the operator-specific results for percutaneous coronary revascularization. Methods and Results From a multicenter database of patients treated since January 1, 1990, we used training and validation samples (n=4860) to develop several models for risk adjustment and applied them to 38 providers performing 25 to 523 procedures in the database. Models were developed using multivariable logistic regression techniques for combinations of the end points of death, myocardial infarction, bypass surgery, and procedural success. Models were evaluated for predictiv...