Characteristics of Early and Late Adopting Hospitals Providing Percutaneous Coronary Intervention in Taiwan

Abstract

BackgroundStudies in the United States suggested that the characteristics of hospitals providing percutaneous coronary intervention (PCI) differed from those not providing PCI. However, little is known on the differences between the characteristics of early‐adopting hospitals and those of late‐adopting hospitals, and on their potential impacts on PCI volume and access.Methods and ResultsWe used inpatient claims data from 1997 to 2012 from the Taiwan National Health Insurance program to identify the hospitals offering PCI. Geographic information systems (GIS) were used to determine the population access to PCI hospital. As of 2012, 88 hospitals were capable of providing PCI. On the basis of the year that the hospitals started providing PCI, 32 hospitals were designated as early adopters (before 1998), 23 as early majority (1998–2002), 24 as late majority (2003–2007), and 16 as laggards (2008–2012). Hospitals that adopted PCI later were smaller in size and closer to an existing PCI hospital and had lower PCI volumes performed and less bypass surgery support. The median PCI volumes in 2012 were n=706, 330, 138, and 81 in early adopters, early majority, late majority, and laggards, respectively. Despite the low volume of PCI performed in laggard hospitals, the percentage with ST‐elevation myocardial infarction and acute myocardial infarction as principal discharge diagnosis was higher than their early‐adopting hospital counterparts. The percentage of the Taiwanese population living within 40 km of PCI hospitals (appropriate access defined in this study) was 95.7% in 1997 and 98.0% in 2002, and this has remained unchanged since 2002.ConclusionsThe characteristics of early‐adopting hospitals differed from those of late‐adopting hospitals. Despite lower PCI volume performed in late‐adopting hospitals, many of them are in remote areas and provide needed and timely services for patients with acute myocardial infarction.

Trimethylamine N-oxide and the reverse cholesterol transport in cardiovascular disease: a cross-sectional study

“…Therefore, the microbial origin of TMA is of great interest. Indeed, a major role is played by the microbiome in regulating health and well-being 48 , and dysbiosis of the gut microbiota has been measured in stroke and transient ischemic attack patients whose blood TMAO levels were decreased 49 .…”

When high‐volume PCI operators in high‐volume hospitals move to lower volume hospitals—Do they still maintain high volume and quality of outcomes?

“…Five out of six operators moved from high‐volume hospitals to moderate or low‐volume hospitals moving occurred post‐COURAGE (2008 afterward). One possible explanation was the rapid expansion of community hospitals (especially in remote areas) providing PCI services because of the Door‐to‐Balloon initiation launched by the Ministry of Health and Welfare and the Taiwan Joint Commission on Hospital Accreditation . Economic incentives due to the healthcare policy environment to offer PCI capabilities do have impacts on the expansion of the number of PCI centers.…”

“…However, the rates of 30-day and 1-year death, MI, or target vessel revascularization decreased by 3% for every 100 patients or more treated at a single institution, suggesting that hospital characteristics are more important predictors than operator characteristics [7]. Accreditation [14]. Economic incentives due to the healthcare policy environment to offer PCI capabilities do have impacts on the expansion of the number of PCI centers.…”

“…Because all patients receiving PCIs in Taiwan are required to be hospitalized for observation, we assessed only the inpatient claims data, but not the outpatient claims data. The inpatient claims data include diagnosis and procedure codes, various service fees, patient characteristics, attending physician characteristics, and some characteristics of hospitals . We used the International Classification of Disease, Ninth Revision, Clinical Modification (ICD‐9‐CM) procedure codes 36.01, 36.02, 36.05, 36.06, and 36.09, which are recorded in five of the discharge procedure columns in the inpatient claims data, to identify patients receiving PCIs.…”

Trends in proportions of hospitals and operators not meeting minimum percutaneous coronary intervention volume standards in Taiwan, 2001–2013

“…Hospitalized observation is required for patients undergoing PCIs in Taiwan. This study uses inpatient claims data, which include diagnostic and procedural codes, service fees, patient characteristics, attending physicians, and certain hospital characteristics . To identify patients receiving PCIs, the International Classification of Disease, 9th Revision, Clinical Modification (ICD‐9‐CM) procedure codes 36.01, 36.02, 36.05, 36.06, and 36.09 are first employed; these are recorded in five of the discharge procedure columns in NHI inpatient claims data.…”