Registry Studies for Improving the Quality of Cardiovascular Care

In this issue of Circulation: Cardiovascular Quality and Outcomes, 2 seemingly unrelated articles appear that utilize clinical registry data: Curtis et al1 utilize the American College of Cardiology’s CathPCI Registry to calculate hospital-specific 30-day risk standardized mortality rates following percutaneous coronary intervention whereas Likosky and colleagues2 exploit the Northern New England Cardiovascular Disease Study Group’s cardiac surgery registry to identify factors associated with patient-specific low output failure after coronary bypass grafting surgery. The former is concerned with estimating between-hospital variation in patient outcomes and the latter aims to quantify between-surgeon and between-patient variations in patient outcomes. Although the questions are similar, the authors have focused on different statistical summary measures.Curtis and colleagues use > 100 000 admissions to assess quality of hospital care across 602 hospitals and estimate hospital-specific performance measures using hierarchical (or random effects) logistic regression models. Likosky and colleagues study …