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Related Experiment Videos

Comparing performance between coronary intervention centres requires detailed case-mix adjusted analysis.

M A Denvir1, A J Lee, J Rysdale

  • 1Western General Hospital, Crewe Road, Edinburgh. mdenvir@staffmail.ed.ac.uk

Journal of Public Health (Oxford, England)
|July 31, 2004
PubMed
Summary

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Comparing percutaneous coronary intervention (PCI) costs and outcomes at two centers revealed higher stent use and costs at one center. After adjusting for patient case-mix, differences in repeat PCI and overall revascularization were not significant.

Area of Science:

  • Cardiovascular Medicine
  • Health Economics
  • Interventional Cardiology

Background:

  • Interventional cardiology centers may exhibit variations in clinical outcomes and procedural costs.
  • Differences in patient case-mix can influence observed outcomes and cost-effectiveness analyses.

Purpose of the Study:

  • To compare 12-month clinical outcomes and procedural costs between two interventional cardiology centers with differing crude mortality and revascularization rates.
  • To assess the impact of case-mix adjustment on the comparison of outcomes and costs.

Main Methods:

  • Linked percutaneous coronary intervention (PCI) registry data with hospital discharge and death records for 1046 patients.
  • Developed a procedural cost model based on equipment use, length of stay, and staff from 100 cases per center.

Related Experiment Videos

  • Utilized Cox regression analysis to adjust for case-mix differences.

    • Main Results:

    • One center used stents more frequently (56% vs. 26%), incurring higher procedural costs (GBP 1970 vs. GBP 1521).
    • The center with higher stent use showed significantly greater rates of repeat target vessel PCI (10.3% vs. 5.6%) and overall repeat revascularization (18.4% vs. 10.8%).
    • After case-mix adjustment, the difference in repeat target vessel PCI between centers was no longer statistically significant (p=0.15).

    Conclusions:

    • Crude differences in cost, mortality, and revascularization rates between the two centers were largely explained by variations in patient case-mix.
    • Comparisons of outcomes and costs between healthcare centers require careful adjustment for case-mix to ensure accurate interpretation.