Is more better? A multilevel analysis of percutaneous coronary intervention hospital openings and closures on patient volumes.

Autor:	Hsia, Renee Y., Redberg, Rita F., Shen, Yu‐Chu
Předmět:	HOSPITAL closures COMMUNITY health services HEALTH facility administration RESEARCH funding MEDICARE FEE for service (Medical fees) RETROSPECTIVE studies DESCRIPTIVE statistics LONGITUDINAL method PERCUTANEOUS coronary intervention ATTITUDES of medical personnel MEDICAL records ACQUISITION of data ELECTIVE surgery HEALTH facilities PATIENTS' attitudes BUILT environment
Zdroj:	Academic Emergency Medicine; Oct2024, Vol. 31 Issue 10, p994-1005, 12p
Abstrakt:	Background: It is unknown how changes in the percutaneous coronary intervention (PCI) "built environment" have impacted PCI volumes at the community, hospital, and patient levels. This study sought to determine how PCI hospital openings and closures effect community‐ and hospital‐level PCI volumes as well as the likelihood of receiving PCI at a low‐volume hospital. Methods: We conducted a retrospective cohort study of 3,966,025 Medicare Fee‐For‐Service patients in 37,451 zip codes and 2564 U.S. hospitals who underwent PCI from 2006 to 2017. We conducted community‐, hospital‐, and patient‐level analyses using ordinary least squares regressions with fixed effects to determine changes in PCI volumes after PCI hospital openings or closures. Results: Between 2006 and 2017, a total of 17% and 7% of patients lived in communities that experienced PCI hospital openings and closures, respectively. Openings were associated with a 10% increase in community PCI volume, a 2% increase in the share of elective PCI, and a doubling in the likelihood of receiving PCI at a low‐volume hospital. In communities with low baseline PCI capacity, openings were associated with a 12% increase in community PCI volume, and in high‐capacity communities, an 8% increase. PCI closures were associated with a 9% decrease in community PCI volume in high‐capacity communities but no measurable change in low‐capacity communities. Conclusions: PCI service expansion is associated with increased PCI at low‐volume hospitals and a greater number of elective procedures. Increased governmental oversight may be necessary to ensure that openings and closures of these specialized services yield the desired benefits. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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