Analysis of VA CART Program Shows Value of PCI Can Be Improved

January 19, 2015—One-year findings from the VA CART (Veterans’ Administration Clinical Assessment, Reporting, and Tracking) program, which analyzed 1-year outcomes (risk-adjusted mortality) and costs of percutaneous coronary intervention (PCI) in the VA system from 2007 to 2010, were published by P. Michael Ho, MD, et al in the Journal of the American College of Cardiology (JACC) (2015;65:236–242). The study's background is that the longitudinal outcomes and costs for patients after PCI provide an opportunity to measure an aspect of health care value.

The investigators concluded that there is much less variation in 1-year risk-adjusted mortality than in risk-standardized costs after PCI in the VA. These findings suggest that there are opportunities to improve PCI value by reducing costs without compromising outcomes. This approach to evaluating outcomes and costs together may be a model for other health systems and accountable care organizations interested in operationalizing value measurement, stated the investigators in JACC.

This retrospective cohort study evaluated all veterans undergoing PCI at any of 60 hospitals in the VA health care system, using data from the national VA CART program. Primary outcomes were 1-year mortality and costs after PCI. Risk-standardized mortality and cost ratios were calculated, adjusting for cardiac and noncardiac comorbidities.

The investigators found that a median of 261 PCIs were performed in the 60 hospitals during the study period. Median 1-year unadjusted hospital mortality rate was 6.13%. Four hospitals were significantly above the 1-year risk-standardized median mortality rate, with median mortality ratios ranging from 1.23 to 1.28. No hospitals were significantly below median mortality.

Median 1-year total unadjusted hospital costs were $46,302 per patient. There were 16 hospitals above and 19 hospitals below the risk-standardized median cost, with risk-standardized ratios ranging from 0.45 to 2.09, reflecting a much larger magnitude of variability in costs than in mortality, reported the investigators in JACC.