WHAT IS KNOWN? We know
New Research PaperCoronaryDo PCI Facility Openings and Closures Affect AMI Outcomes Differently in High- vs Average-Capacity Markets?
Central Illustration
Section snippets
Data Sources
We used the 100% Medicare Provider and Analysis Review (MedPAR) and Medicare outpatient claims between 2005 and 2017 to identify PCI volume and the patient cohort. We used the American Hospital Association and the Healthcare Cost Report Information System to identify hospital characteristics, including their geographical coordinates. We used 2010 U.S. Census and 2011-2018 American Community Surveys to identify each ZIP Code community’s geographical coordinates and demographic information.
Results
Our study included 2,742,530 patients from 2006-2017. By study design, about one-quarter of patients lived in a high-capacity market, while the remaining three-quarters lived in an average-capacity market. Table 1 shows that communities that were classified as having high PCI capacity at baseline had a lower proportion of Black residents (9%) compared with communities with average PCI capacity at baseline (14%), as well as a lower proportion of low-income families (29% compared with 34% for
Discussion
In this analysis of PCI hospital openings and closures using national data from 2006 to 2017, PCI center openings within a 15-minute drive in average-capacity markets were associated with significant benefits in treatment access and outcomes for patients with AMI. These effects were not seen in high-capacity PCI markets. Specifically, in average-capacity markets, patients with AMI had a 6.5% and 8.6% relative increase in the likelihood of receiving revascularization on the day of admission and
Conclusions
PCI capacity has continued to grow in all communities, including communities with high baseline capacity, since 2006. Our findings lend credence to the notion that the opening of PCI services in a hospital has markedly different effects on communities depending on their baseline access to PCI services. Patients with AMI in average-capacity markets benefit substantially, whereas the effect observed for patients in high-capacity markets is small—or possibly even detrimental.
Funding Support and Author Disclosures
This project was supported by the National Heart, Lung, and Blood Institute grants R01HL134182 and R01HL114822, and National Institute on Aging grant P30AG012810. Dr Krumholz has received expenses and/or personal fees from UnitedHealth, Element Science, Eyedentifeye, and F-Prime in the past three years; is a co-founder of Refactor Health and HugoHealth; and he is associated with contracts, through Yale New Haven Hospital, from the Centers for Medicare & Medicaid Services and through Yale
Acknowledgment
The authors thank Maddie Feldmeier for editorial assistance.
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Cited by (1)
PCI Facility Openings and Closures: If You Build It, Will They Benefit?
2023, JACC: Cardiovascular Interventions
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