{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T15:23:12Z","timestamp":1761578592045},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2015,1]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Post-percutaneous coronary intervention (PCI) bleeding complications are an important quality metric. We sought to characterize site-level variation in post-PCI bleeding and explore the influence of patient and procedural factors on hospital bleeding performance.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Hospital-level bleeding performance was compared pre- and postadjustment using the newly revised CathPCI Registry\n              <jats:sup>\u00ae<\/jats:sup>\n              bleeding risk model (c-index, 0.77) among 1292 National Cardiovascular Data Registry\n              <jats:sup>\u00ae<\/jats:sup>\n              hospitals performing &gt;50 PCIs from 7\/2009 to 9\/2012 (n=1\u2009984\u2009998 procedures). Using random effects models, outlier sites were identified based on 95% confidence intervals around the hospital\u2019s random intercept. Bleeding 72 hours post-PCI was defined as: arterial access site, retroperitoneal, gastrointestinal, or genitourinary bleeding; intracranial hemorrhage; cardiac tamponade; nonbypass surgery\u2013related blood transfusion with preprocedure hemoglobin \u22658 g\/dL; or absolute decrease in hemoglobin value \u22653\u2009g\/dL with preprocedure hemoglobin \u226416 g\/dL. Overall, the median unadjusted post-PCI bleeding rate was 5.2% and varied among hospitals from 2.6% to 10.4% (5th, 95th percentiles). Center-level bleeding variation persisted after case-mix adjustment (2.8%\u20139.5%; 5th, 95th percentiles). Although hospitals\u2019 observed and risk-adjusted bleeding ranks were correlated (Spearman \u03c1: 0.88), individual rankings shifted after risk-adjustment (median \u0394 rank order: \u00b191.5; interquartile range: 37.0, 185.5). Outlier classification changed postadjustment for 29.3%, 16.1%, and 26.5% of low-, non-, and high-outlier sites, respectively. Hospital use of bleeding avoidance strategies (bivalirudin, radial access, or vascular closure device) was associated with risk-adjusted bleeding rates.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Despite adjustment for patient case-mix, there is wide variation in rates of hospital PCI-related bleeding in the United States. Opportunities may exist for best performers to share practices with other sites.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.113.000749","type":"journal-article","created":{"date-parts":[[2014,11,26]],"date-time":"2014-11-26T03:37:52Z","timestamp":1416973072000},"page":"15-22","update-policy":"http:\/\/dx.doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Identification of Hospital Outliers in Bleeding Complications After Percutaneous Coronary Intervention"],"prefix":"10.1161","volume":"8","author":[{"given":"Connie N.","family":"Hess","sequence":"first","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (C.N.H., S.V.R., L.A.M., M.L.N., E.D.P.); Mayo Clinic, Rochester, MN (M.S.); Saint Luke\u2019s Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (R.J.K.); and Henry Ford Heart and Vascular Institute, Detroit, MI (W.D.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil V.","family":"Rao","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (C.N.H., S.V.R., L.A.M., M.L.N., E.D.P.); Mayo Clinic, Rochester, MN (M.S.); Saint Luke\u2019s Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (R.J.K.); and Henry Ford Heart and Vascular Institute, Detroit, MI (W.D.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa A.","family":"McCoy","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (C.N.H., S.V.R., L.A.M., M.L.N., E.D.P.); Mayo Clinic, Rochester, MN (M.S.); Saint Luke\u2019s Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (R.J.K.); and Henry Ford Heart and Vascular Institute, Detroit, MI (W.D.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan L.","family":"Neely","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (C.N.H., S.V.R., L.A.M., M.L.N., E.D.P.); Mayo Clinic, Rochester, MN (M.S.); Saint Luke\u2019s Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (R.J.K.); and Henry Ford Heart and Vascular Institute, Detroit, MI (W.D.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandeep","family":"Singh","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (C.N.H., S.V.R., L.A.M., M.L.N., E.D.P.); Mayo Clinic, Rochester, MN (M.S.); Saint Luke\u2019s Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (R.J.K.); and Henry Ford Heart and Vascular Institute, Detroit, MI (W.D.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John A.","family":"Spertus","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (C.N.H., S.V.R., L.A.M., M.L.N., E.D.P.); Mayo Clinic, Rochester, MN (M.S.); Saint Luke\u2019s Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (R.J.K.); and Henry Ford Heart and Vascular Institute, Detroit, MI (W.D.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald J.","family":"Krone","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (C.N.H., S.V.R., L.A.M., M.L.N., E.D.P.); Mayo Clinic, Rochester, MN (M.S.); Saint Luke\u2019s Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (R.J.K.); and Henry Ford Heart and Vascular Institute, Detroit, MI (W.D.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W. Douglas","family":"Weaver","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (C.N.H., S.V.R., L.A.M., M.L.N., E.D.P.); Mayo Clinic, Rochester, MN (M.S.); Saint Luke\u2019s Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (R.J.K.); and Henry Ford Heart and Vascular Institute, Detroit, MI (W.D.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric D.","family":"Peterson","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (C.N.H., S.V.R., L.A.M., M.L.N., E.D.P.); Mayo Clinic, Rochester, MN (M.S.); Saint Luke\u2019s Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (R.J.K.); and Henry Ford Heart and Vascular Institute, Detroit, MI (W.D.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31823ac046"},{"key":"e_1_3_4_3_2","unstructured":"Cardiovascular endorsement maintenance 2010 technical report. 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