The Case for Community Hospital Angioplasty

Wharton, Thomas P.

doi:10.1161/circulationaha.104.478362

Cited by 27 publications

(4 citation statements)

References 169 publications

(119 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4 Alternatively, hospitals may adopt new cardiac services for competitive reasons – for example, because these services are profitable because they are well reimbursed, attract patients, or attract doctors -- although expansions may be in areas where services are already widely available. This would contribute to decreased local expertise from lower volume within a market, increased variation in treatment and outcomes(5,6) or possible overuse without clear medical indication.…”

Section: Introductionmentioning

confidence: 99%

Expansion of Invasive Cardiac Services in the United States

et al. 2013

View full text Add to dashboard Cite

Background The number of hospitals offering invasive cardiac services (diagnostic angiography, percutaneous coronary intervention [PCI], and coronary artery bypass grafting [CABG]) has expanded, yet national patterns of service diffusion and their effect on geographic access to care are unknown. Methods and Results Retrospective cohort study of all hospitals in fee-for-service Medicare, 1996–2008. Logistic regression identified the relationship between cardiac service adoption and the proportion of neighboring hospitals within 40 miles already offering the service. From 1996–2008, 397 hospitals began offering diagnostic angiography, 387 PCI, and 298 CABG (increasing the proportion with services by 3%, 11%, and 4% respectively). This capacity increase led to little new geographic access to care; the population increase in geographic access to diagnostic angiography was 1 percentage point; PCI 5 percentage points, and CABG 4 percentage points. Controlling for hospital and market characteristics, a 10 percentage point increase in the proportion of nearby hospitals already offering the service increased the odds by 10% that a hospital would add diagnostic angiography (OR: 1.102; 95% CI: 1.018, 1.193), increased the odds by 79% that it would add PCI (OR: 1.794, 95% CI: 1.288, 2.498), and had no significant effect on adding CABG (OR 0.929, 95% CI, 0.608, 1.420). Conclusions Hospitals are most likely to introduce new invasive cardiac services when neighboring hospitals already offer such services. Increases in the number of hospitals offering invasive cardiac services have not led to corresponding increases in geographic access.

show abstract

Section: Introductionmentioning

confidence: 99%

Expansion of Invasive Cardiac Services in the United States

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Prompted by numerous studies describing an inverse relationship between volume and outcome, several policy efforts are attempting to concentrate complex procedures in high-volume hospitals[1,2]. A systematic review of the volume-outcome relationship found that 71% of all studies of hospital volume and 69% of studies of physician volume reported a statistically significant association between higher volume and better health outcomes[1].…”

Section: Introductionmentioning

confidence: 99%

Practice size, caseload, deprivation and quality of care of patients with coronary heart disease, hypertension and stroke in primary care: national cross-sectional study

Saxena

Car

Eldred

et al. 2007

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundReports of higher quality care by higher-volume secondary care providers have fuelled a shift of services from smaller provider units to larger hospitals and units. In the United Kingdom, most patients are managed in primary care. Hence if larger practices provide better quality of care; this would have important implications for the future organization of primary care services. We examined the association between quality of primary care for cardiovascular disease achieved by general practices in England and Scotland by general practice caseload, practice size and area based deprivation measures, using data from the New General Practitioner (GP) Contract.MethodsWe analyzed data from 8,970 general practices with a total registered population of 55,522,778 patients in England and Scotland. We measured practice performance against 26 cardiovascular disease (coronary heart disease, left ventricular disease, and stroke) Quality and Outcomes Framework (QOF) indicators for patients on cardiovascular disease registers and linked this with data on practice characteristics and census data.ResultsDespite wide variations in practice list sizes and deprivation, the prevalence of was remarkably consistent, (coronary heart disease, left ventricular dysfunction, hypertension and cerebrovascular disease was 3.7%; 0.45%; 11.4% and 1.5% respectively). Achievement in quality of care for cardiovascular disease, as measured by QOF, was consistently high regardless of caseload or size with a few notable exceptions: practices with larger list sizes, higher cardiovascular disease caseloads and those in affluent areas had higher achievement of indicators requiring referral for further investigation. For example, small practices achieved lower scores 71.4% than large practices 88.6% (P < 0.0001) for referral for exercise testing and specialist assessment of patients with newly diagnosed angina.ConclusionThe volume-outcome relationship found in hospital settings is not seen between practices in the UK in management of cardiovascular disorders in primary care. Further work is warranted to explain apparently poorer quality achievement in some aspects of cardiovascular management relating to initial diagnosis and management among practices in deprived areas, smaller practices and those with a smaller caseload.

show abstract

“…Treatment in off-site centres results in a significant reduction in time-to-treatment, which could potentially lead to a reduction in infarct size by more timely salvage of acutely jeopardised ischaemic myocardium [4–6]. In that respect, off-site PCI without transfer delay in STEMI patients might even prove to be superior in limiting infarct size [7,8]. …”

Section: Introductionmentioning

confidence: 99%

Long-term Clinical Outcome and MIBI SPECT Parameters in Percutaneous Coronary Interventions

et al. 2011

View full text Add to dashboard Cite

Background and AimPrimary percutaneous coronary intervention (PCI) is the preferred treatment option for acute myocardial infarction (MI). Off-site PCI reduces time-to-treatment, which could potentially lead to enhanced clinical outcomes. Therefore, we investigated whether off-site PCI improves 5-year clinical outcomes compared with on-site PCI and whether this is related to in-hospital 99mTc-sestamibi single photon emission computed tomography (MIBI SPECT) parameters.MethodsWe describe the 5-year follow-up for a combined endpoint of death or re-infarction in 128 patients with acute MI who were randomly assigned to undergo primary PCI at the off-site centre (n = 68) or to transferral to an on-site centre (n = 60). Three days after PCI, MIBI SPECT was performed to estimate infarct size. A multivariate Cox regression model was created to study the relation between MIBI SPECT parameters and long-term clinical outcomes.ResultsAfter a mean follow-up of 5.8 ± 1.1 years, 25 events occurred. Off-site PCI significantly reduced door-to-balloon time compared with on-site PCI (94 ± 54 versus 125 ± 59 min, p = 0.003). However, infarct size (17 ± 15 versus 14 ± 12%, p = 0.34) and 5-year death or infarct rate (21% versus 18%, p = 0.75) were comparable between treatment centres. With multivariate analysis, only Killip class ≥2 and Q wave MI, but not scintigraphic data, predicted long-term clinical outcomes.ConclusionOff-site PCI reduced door-to-balloon time with a comparable 5-year death or infarct rate. Parameters from resting MIBI SPECT on day 3 after MI did not predict long-term clinical outcomes.

show abstract

The Case for Community Hospital Angioplasty

Cited by 27 publications

References 169 publications

Expansion of Invasive Cardiac Services in the United States

Expansion of Invasive Cardiac Services in the United States

Practice size, caseload, deprivation and quality of care of patients with coronary heart disease, hypertension and stroke in primary care: national cross-sectional study

Long-term Clinical Outcome and MIBI SPECT Parameters in Percutaneous Coronary Interventions

Contact Info

Product

Resources

About