Affiliation:
1. Department of Emergency Medicine University of California San Francisco California USA
2. Philip R. Lee Institute for Health Policy Studies University of California San Francisco California USA
3. Division of Cardiology, Department of Medicine University of California San Francisco California USA
4. Department of Defense Management Naval Postgraduate School Monterey California USA
5. National Bureau of Economic Research Cambridge Massachusetts USA
Abstract
AbstractBackgroundIt 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.MethodsWe 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.ResultsBetween 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.ConclusionsPCI 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.
Funder
National Heart, Lung, and Blood Institute
National Institute on Aging
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