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High-technology cardiac procedures. The impact of service availability on service use in New York State
1Health Research Program, Wagner Graduate School, New York University, NY.
Insights
Hospital availability of cardiac procedures like bypass surgery significantly impacts their use after acute myocardial infarction (AMI). Patients presenting to hospitals with more services received them more often, highlighting the importance of cardiac care access.
Area of Science:
- Cardiology
- Health Services Research
- Public Health
Background:
- Access to cardiac procedures following acute myocardial infarction (AMI) can be influenced by hospital resources.
- Understanding this relationship is crucial for optimizing post-MI care pathways.
Purpose of the Study:
- To investigate how the in-hospital availability of cardiac catheterization, bypass surgery, and angioplasty affects their utilization in patients after AMI.
- To determine if initial hospital resources influence the likelihood of receiving these procedures during admission or post-discharge.
Main Methods:
- Retrospective cohort study utilizing a statewide hospital discharge abstract data set.
- Analysis of patients admitted with AMI in New York State hospitals (March-June 1986).
- Calculation of odds ratios (ORs) for procedure utilization based on hospital service availability, adjusted for patient and hospital factors.
Main Results:
- Patients presenting to hospitals with cardiac catheterization services were more likely to undergo catheterization (OR, 3.57).
- Patients presenting to hospitals offering all three services (catheterization, bypass, angioplasty) had significantly higher odds of undergoing all three procedures compared to those presenting to hospitals with no services.
- Specifically, odds for catheterization (OR, 5.50), bypass surgery (OR, 2.52), and angioplasty (OR, 6.85) were elevated.
Conclusions:
- The availability of cardiac procedures within a hospital strongly influences their use in patients experiencing acute myocardial infarction.
- Hospital-based cardiac service availability is a key determinant of post-MI procedural care.
Objective:
To study the impact of the in-hospital availability of three cardiac procedures (cardiac catheterization, bypass surgery, and angioplasty) on their use in patients during the period following acute myocardial infarction (AMI).
Design:
Retrospective cohort study, based on a statewide hospital discharge abstract data set.
Participants:
Patients admitted with a principal diagnosis of AMI to New York State hospitals during March through June of 1986.
Main Outcome Measures:
The odds of utilizing each of the three services either during the initial admission for AMI or during the 6-month postdischarge interval. Odds ratios (ORs) were calculated comparing utilization in three groups of patients: those initially presenting to hospitals lacking all three services, those initially presenting to hospitals offering only cardiac catheterization, and those initially presenting to hospitals offering all three of the cardiac services. Odds were adjusted for age, sex, race, income, primary payer, severity of illness, and geographical distance to hospital.
Results:
Relative to patients initially presenting to hospitals lacking all three services, patients initially presenting to hospitals offering only cardiac catheterization were more likely to undergo cardiac catheterization (OR, 3.57; 95% confidence interval [Cl], 3.03 to 4.22), but were not significantly more likely to undergo bypass surgery or angioplasty. Relative to patients initially presenting to hospitals lacking all three services, patients initially presenting to hospitals offering all three services were more likely to undergo cardiac catheterization (OR, 5.50; 95% Cl, 4.66 to 6.50), bypass surgery (OR, 2.52; 95% Cl, 1.95 to 3.24), and angioplasty (OR, 6.85; 95% Cl, 4.73 to 10.58).
Conclusions:
The availability of cardiac services in the hospital to which patients initially present strongly influences the likelihood of their use in the period following AMI.