Evidence of systematic duplication by new percutaneous coronary intervention programs

Area of Science:

• Health Services Research
• Cardiovascular Medicine
• Health Economics

Background:

• Evidence indicates that investments in percutaneous coronary intervention (PCI) programs have not enhanced timely reperfusion access for ST-segment elevation myocardial infarction patients.
• Recent and projected investments in PCI may not align with improving patient outcomes.

Purpose of the Study:

• To estimate the number and cost of new PCI programs established in US hospitals between 2004 and 2008.
• To identify characteristics of hospitals, neighborhoods, and states associated with new PCI program introductions.

Main Methods:

• A discrete-time hazard model was employed to analyze factors influencing the decision to establish new PCI programs.
• Data from 2004 to 2008 were used to assess changes in PCI program availability and population access.

Main Results:

• The number of US hospitals performing PCI increased by 16.5% (251 hospitals) from 2004 to 2008.
• Population access to timely PCI grew by only 1.8% during the study period.
• New PCI programs were more prevalent in areas with existing programs, higher insurance rates, weaker regulation, and wealthier hospitals.

Conclusions:

• New PCI programs were found to be systematically duplicative of existing services.
• These new programs did not improve patient access to timely percutaneous coronary intervention.
• The substantial cost of new PCI programs raises concerns about their value for patient care.