Key result
Compared with MI access hospitals, risk-adjusted mortality for nonelective patients was lower at legacy hospitals (OR 0.59; 95% CI 0.48-0.72) and new-CON hospitals (OR 0.55; 95% CI 0.45-0.65).
Why the study?
It is unclear how to geographically distribute PCI programs to optimize patient outcomes, which programs like the Washington State Certificate of Need seek to balance through regulation of elective PCI.
Does hospital PCI service level and volume affect risk-adjusted mortality and geographic access for nonelective PCI patients?
Cohort
Yes
Does hospital PCI service level and volume affect risk-adjusted mortality and geographic access for nonelective PCI patients?
Odds Ratio: 0.59 (95% CI 0.48–0.72)
The Certificate of Need strategy in Washington State created a tiered system where low-volume centers treat high-risk patients with worse mortality outcomes, without significantly improving geographic access to PCI.
Certificate of Need regulation may support higher PCI volumes without compromising access; leaves open whether this model improves outcomes elsewhere.
Background It is unclear how to geographically distribute percutaneous coronary intervention (PCI) programs to optimize patient outcomes. The Washington State Certificate of Need program seeks to balance hospital volume and patient access through regulation of elective PCI. Methods and Results We performed a retrospective cohort study of all non‐Veterans Affairs hospitals with PCI programs in Washington State from 2009 to 2018. Hospitals were classified as having (1) full PCI services and surgical backup ( legacy hospitals, n=17); (2) full services without surgical backup ( new certificate of need [CON] hospitals, n=9); or (3) only nonelective PCI without surgical backup ( myocardial infarction [MI] access hospitals, n=9). Annual median hospital‐level volumes were highest at legacy hospitals (605, interquartile range, 466–780), followed by new CON , (243, interquartile range, 146–287) and MI access , (61, interquartile range, 23–145). Compared with MI access hospitals, risk‐adjusted mortality for nonelective patients was lower for legacy (odds ratio [OR], 0.59 [95% CI, 0.48–0.72]) and new‐CON hospitals (OR, 0.55 [95% CI, 0.45–0.65]). Legacy hospitals provided access within 60 minutes for 90% of the population; addition of new CON and MI access hospitals resulted in only an additional 1.5% of the population having access within 60 minutes. Conclusions Many PCI programs in Washington State do not meet minimum volume standards despite regulation designed to consolidate elective PCI procedures. This CON strategy has resulted in a tiered system that includes low‐volume centers treating high‐risk patients with poor outcomes, without significant increase in geographic access. CON policies should re‐evaluate the number and distribution of PCI programs.
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Kataruka et al. (2022) conducted a cohort in Percutaneous coronary intervention (PCI). Treatment at legacy hospitals (full PCI services and surgical backup) vs. Treatment at MI access hospitals (nonelective PCI without surgical backup) was evaluated on Risk-adjusted mortality for nonelective patients (OR 0.59, 95% CI 0.48-0.72). Compared with MI access hospitals, risk-adjusted mortality for nonelective patients was lower at legacy hospitals (OR 0.59; 95% CI 0.48-0.72) and new-CON hospitals (OR 0.55; 95% CI 0.45-0.65).
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