The Relationship between the Supply of Cardiac Catheterization Laboratories, Cardiologists and the use of Invasive Cardiac Procedures in Northern New England

Abstract

Our work suggests that current efforts to address variation in cardiac procedures through activities such as appropriateness criteria, guidelines and utilization review are misdirected and should be redirected towards capacity, in this case the supply of catheterization facilities.

The relationship between physician supply, cardiovascular health service use and cardiac disease burden in Ontario: Supply-need mismatch

“…Our results reaffirm the importance of supply factors on physician decision-making behaviours in Canada (8), like elsewhere (9,13,14), and underscore the fact that supply may overshadow medical needs as a determinant of health service use in the population (5,30,31).…”

“…Hospitalizations were geographically attributed to the patient's county of residence based on postal code data. Hospitalization data provides a surrogate for the 'expressed' health service needs and disease burden prevalence of a population, and have been used as markers of population need in other studies (9,11,20,21). As a further assessment of validity, county-specific cardiac hospitalization rates in 2000 were found to be positively correlated with the prevalence of county-specific, self-reported cardiovascular risk factors (ie, defined by the presence of smoking, hypertension, diabetes and heart disease), as obtained from the 1996 Ontario Health Survey (www.apheo.ca/indicators) (r=0.59, P<0.0001).…”

“…While onsite procedural hospital capacity remains an important determinant of coronary invasive service use (8,9), available evidence has demonstrated marked variations in the use of noninvasive and medical services in Canada and the United States (7,10,11). Given the importance of physician decision making as a determinant of cardiovascular specialty service use (12), one may reasonably hypothesize that variations in physician supply play a more important determining factor in accounting for interregional cardiovascular referral and management disparities than differences in cardiovascular disease burden (7,13,14).…”

Use of adjuvant radiotherapy at hospitals with and without on‐site radiation services

“…1 At the population level, the number of cardiac catheterization beds in a referral region is correlated positively with rates of invasive cardiac procedures, but not with the incidence of coronary artery disease. 2 Such supplier-induced demand seems to be more prevalent for discretionary clinical situations-those for which physician decisions about treatment are not tightly constrained by medical evidence and clinical consensus. 3,4 Although relations between supply and utilization have not been studied well in cancer treatment, it is plausible that the use of radiotherapy may be influenced by the local availability of such services.…”

Rightsizing Invasive Cardiac Services in the United States

“…16 Additional research shows that the opening of specialty cardiac hospitals is associated with higher population-based rates of coronary revascularization within a hospital referral region despite no differences in the underlying health of the patient population.…”