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

Liang, Fu-Wen; Lee, Jo Chi; Lu, Tsung Hsueh; Yin, Wei Hsian

doi:10.1002/ccd.27343

Cited by 2 publications

(3 citation statements)

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“…One recent analysis using NCDR CathPCI Registry Data reports that for California, 66% of PCIs performed in 2016, 67% in 2017, and 63% in 2018 were non-elective [ 49 – 51 ]. Thus, we estimated that at least 75% of all PCI would qualify as inpatient procedures, using a <150 inpatient PCI volume threshold to approximate the <200 total PCI/year volume referenced in the ACCF/AHA/SCAI guidelines and used by similar PCI volume threshold studies [ 52 ]. Finally, approximately 60% of our cohort had a principal diagnosis code of acute MI, consistent with the proportion of emergent PCI reported in studies using the NCDR registry [ 27 , 28 ], suggesting that inpatient PCI data may still provide a reliable approximation of total PCI volume.…”

Section: Discussionmentioning

confidence: 99%

Trends in the likelihood of receiving percutaneous coronary intervention in a low-volume hospital and disparities by sociodemographic communities

et al. 2023

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Introduction Over the past two decades, percutaneous coronary intervention (PCI) capacity has increased while coronary artery disease has decreased, potentially lowering per-hospital PCI volumes, which is associated with less favorable patient outcomes. Trends in the likelihood of receiving PCI in a low-volume center have not been well-documented, and it is unknown whether certain socioeconomic factors are associated with a greater risk of PCI in a low-volume facility. Our study aims to determine the likelihood of being treated in a low-volume PCI center over time and if this likelihood differs by sociodemographic factors. Methods We conducted a retrospective cohort study of 374,066 hospitalized patients in California receiving PCI from January 1, 2010, to December 31, 2018. Our primary outcome was the likelihood of PCI discharges at a low-volume hospital (<150 PCI/year), and secondary outcomes included whether this likelihood varied across different sociodemographic groups and across low-volume hospitals stratified by high or low ZIP code median income. Results The proportion of PCI discharges from low-volume hospitals increased from 5.4% to 11.0% over the study period. Patients of all sociodemographic groups considered were more likely to visit low-volume hospitals over time (P<0.001). Latinx patients were more likely to receive PCI at a low-volume hospital compared with non-Latinx White in 2010 with a 166% higher gap in 2018 (unadjusted proportions). The gaps in relative risk (RR) between Black, Latinx and Asian patients versus non-Latinx white increased over time, whereas the gap between private versus public/no insurance, and high versus low income decreased (interaction P<0.001). In low-income ZIP codes, patients with Medicaid were less likely to visit low-volume hospitals than patients with private insurance in 2010; however, this gap reversed and increased by 500% in 2018. Patients with low income were more likely to receive PCI at low-volume hospitals relative to patients with high income in all study years. Conclusions The likelihood of receiving PCI at low-volume hospitals has increased across all race/ethnicity, insurance, and income groups over time; however, this increase has not occurred evenly across all sociodemographic groups.

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confidence: 99%

Trends in the likelihood of receiving percutaneous coronary intervention in a low-volume hospital and disparities by sociodemographic communities

et al. 2023

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“…In this issue of Catheterization and Cardiovascular Interventions , Liang et al describe a comprehensive nationwide evaluation of PCI volumes in Taiwan . The percentage of low‐volume operators in Taiwan has remained relatively stable from 58% of total operators in 2001 to 60% in 2013 and the number of low‐volume centers decreased significantly from 57% to 33%.…”

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confidence: 99%

“…In defining a “minimum” number of PCIs to be considered competent, we risk encouraging more inappropriate or borderline indicated interventions in order to maintain viability both procedurally and financially. Liang et al clearly demonstrate that the majority of low‐volume centers did not stay low volume over the course of the study and access to PCI is important for both procedure availability and patient satisfaction . Low‐volume centers may increase procedures to achieve minimal volume guidelines as well as financial security, but they also may provide increased access to PCI in rural areas which otherwise may not receive state of the art therapy.…”

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The Quandary of Volume! How Much Is Enough?

Brown

Henry

2018

Cathet Cardio Intervent

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Key Points While the percentage of low‐volume PCI operators (<50/yr) in Taiwan has remained approximately 60% and the percentage of low‐volume centers (<200/yr) has declined from 57% to 33% between 2001 and 2013, the actual number of low‐volume operators and low‐volume centers has increased Recent data from NCDR confirms a modest but consistent inverse relationship between PCI operator volume and adjusted in‐hospital mortality, which is magnified by being a low‐volume center Criteria beyond volume such as procedural complexity, operator experience, and appropriate case selection are important factors in providing exceptional patient care

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

Abstract: Approximately one-third of hospitals and three-fifths of operators in Taiwan failed to meet minimum PCI volume standards. Further research examining patient outcomes from PCIs performed by low-volume hospitals and operators is recommended.

Cited by 2 publications

References 21 publications

Trends in the likelihood of receiving percutaneous coronary intervention in a low-volume hospital and disparities by sociodemographic communities

Trends in the likelihood of receiving percutaneous coronary intervention in a low-volume hospital and disparities by sociodemographic communities

The Quandary of Volume! How Much Is Enough?

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