{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T03:11:16Z","timestamp":1780629076036,"version":"3.54.1"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2012,7]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>In anticipation of applying Appropriate Use Criteria for percutaneous coronary intervention (PCI) quality improvement, we determined the prevalence of appropriate, uncertain, and inappropriate PCIs stratified by indication for all PCIs performed in the state of Washington.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Within the Clinical Outcomes Assessment Program, we assigned appropriateness ratings to all PCIs performed in 2010 in accordance with published Appropriate Use Criteria. Of 13 291 PCIs, we successfully mapped the clinical scenario to the Appropriate Use Criteria in 9924 (75%) cases. Of the 3367 PCIs not classified, common failures to map to the criteria included nonacute PCI without prior noninvasive stress results (n = 1906; 57%) and unstable angina without high-risk features (n = 902; 27%). Of mapped PCIs, 8010 (71%) were for acute indications, with 7887 (98%) rated as appropriate, 39 (&lt;1%) as uncertain, and 84 (1%) as inappropriate. Of 1914 mapped nonacute indications, 847 (44%) were rated as appropriate, 748 (39%) as uncertain, and 319 (17%) as inappropriate. Assuming results for noninvasive stress tests when data were missing, in the best-case scenario, 319 (8%) of nonacute PCIs were classified as inappropriate compared with 1459 (38%) in the worst-case scenario. Variation in inappropriate PCIs by facility was greatest for mapped nonacute indications (median = 14%; 25\n              <jats:sup>th<\/jats:sup>\n              to 75\n              <jats:sup>th<\/jats:sup>\n              percentiles = 9% to 24%) and nonacute indications with missing data precluding appropriateness classification (median = 54%; 25\n              <jats:sup>th<\/jats:sup>\n              to 75\n              <jats:sup>th<\/jats:sup>\n              percentiles = 35% to 66%).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>In a complete cohort of PCIs performed in Washington state, 1% of PCIs for acute indications and 17% of PCIs for nonacute indications were classified as inappropriate. Missing data on noninvasive stress tests present a challenge in the application of the criteria for quality improvement.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.111.964320","type":"journal-article","created":{"date-parts":[[2012,5,9]],"date-time":"2012-05-09T03:58:09Z","timestamp":1336535889000},"page":"445-453","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":46,"title":["Appropriateness of Percutaneous Coronary Interventions in Washington State"],"prefix":"10.1161","volume":"5","author":[{"given":"Steven M.","family":"Bradley","sequence":"first","affiliation":[{"name":"From the VA Eastern Colorado Health Care System and University of Colorado Denver, Denver, CO (S.M.B.); Health Services Research and Development Northwest Center of Excellence, VA Puget Sound Health Care System, and University of Washington, Seattle, WA (C.M., C.L.B.); Clinical Outcomes Assessment Program, Foundation for Health Care Quality, Seattle, WA (C.M., C.L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Maynard","sequence":"additional","affiliation":[{"name":"From the VA Eastern Colorado Health Care System and University of Colorado Denver, Denver, CO (S.M.B.); Health Services Research and Development Northwest Center of Excellence, VA Puget Sound Health Care System, and University of Washington, Seattle, WA (C.M., C.L.B.); Clinical Outcomes Assessment Program, Foundation for Health Care Quality, Seattle, WA (C.M., C.L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris L.","family":"Bryson","sequence":"additional","affiliation":[{"name":"From the VA Eastern Colorado Health Care System and University of Colorado Denver, Denver, CO (S.M.B.); Health Services Research and Development Northwest Center of Excellence, VA Puget Sound Health Care System, and University of Washington, Seattle, WA (C.M., C.L.B.); Clinical Outcomes Assessment Program, Foundation for Health Care Quality, Seattle, WA (C.M., C.L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03550230069040"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)12113-7"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.03.007"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa070829"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2009.02.059"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa072771"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/circoutcomes.108.798462"},{"key":"e_1_3_3_9_2","unstructured":"The Dartmouth Atlas Project. The Dartmouth Atlas of Health Care: Studies of surgical variation. Cardiac surgery report. Available at: http:\/\/www.dartmouthatlas.org\/publications\/reports.aspx. Accessed April 29 2010."},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0b013e3182009701"},{"key":"e_1_3_3_11_2","unstructured":"Agency for Healthcare Research and Quality. Healthcare costs and utilization project. Available at: http:\/\/hcupnet.ahrq.gov. Accessed February 19 2010."},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.10.005"},{"key":"e_1_3_3_13_2","first-page":"53","article-title":"Appropriateness of percutaneous coronary intervention.","volume":"306","author":"Chan PS","year":"2011","unstructured":"Chan PS, Patel MR, Klein LW, Krone RJ, Dehmer GJ, Kennedy K, Nallamothu BK, Weaver WD, Masoudi FA, Rumsfeld JS, Brindis RG, Spertus JA. Appropriateness of percutaneous coronary intervention. JAMA. 2011;306:53\u201361.","journal-title":"JAMA"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(00)01391-6"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2005.06.035"},{"key":"e_1_3_3_16_2","unstructured":"Clinical Outcomes Assessment Program (COAP) A Program of the Foundation for Health Care Quality. http:\/\/www.coap.org Accessed June 10 2011."},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.11.003"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.02.005"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2008.05.007"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2008.08.023"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.708"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/circinterventions.108.846741"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.23.2908"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004815.pub3"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)00397-9"}],"container-title":["Circulation: Cardiovascular Quality and Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCOUTCOMES.111.964320","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T02:55:32Z","timestamp":1715568932000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCOUTCOMES.111.964320"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,7]]},"references-count":24,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2012,7]]}},"alternative-id":["10.1161\/CIRCOUTCOMES.111.964320"],"URL":"https:\/\/doi.org\/10.1161\/circoutcomes.111.964320","relation":{},"ISSN":["1941-7713","1941-7705"],"issn-type":[{"value":"1941-7713","type":"print"},{"value":"1941-7705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,7]]},"assertion":[{"value":"2011-11-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2012-04-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2012-05-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}