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Titolo:
Accreditation of hospitals for percutaneous coronary intervention on the basis of volume or clinical outcome using MEDPAR data sets: Effect on patient mortality, cost and treatment accessibility
Autore:
Ellis, SG; Dushman-Ellis, SJ;
Indirizzi:
Cleveland Clin Fdn, Dept Cardiol, Cleveland, OH 44195 USA Cleveland Clin Fdn Cleveland OH USA 44195 ardiol, Cleveland, OH 44195 USA
Titolo Testata:
JOURNAL OF INVASIVE CARDIOLOGY
fascicolo: 9, volume: 12, anno: 2000,
pagine: 464 - 471
SICI:
1042-3931(200009)12:9<464:AOHFPC>2.0.ZU;2-B
Fonte:
ISI
Lingua:
ENG
Soggetto:
OPERATOR VOLUME; ANGIOPLASTY; CARDIOLOGY;
Keywords:
angioplasty; clinical outcome; cost minimization;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
14
Recensione:
Indirizzi per estratti:
Indirizzo: Ellis, SG Cleveland Clin Fdn, Dept Cardiol, 9500 Euclid Ave,F-25, Cleveland, OH 44195 USA Cleveland Clin Fdn 9500 Euclid Ave,F-25 Cleveland OH USA 44195 A
Citazione:
S.G. Ellis e S.J. Dushman-Ellis, "Accreditation of hospitals for percutaneous coronary intervention on the basis of volume or clinical outcome using MEDPAR data sets: Effect on patient mortality, cost and treatment accessibility", J INVAS CAR, 12(9), 2000, pp. 464-471

Abstract

Background The risk of major complications of percutaneous coronary revascularization (PCR) is modestly lower in high-volume as opposed to few-volumehospitals, but this is not a consistent finding for all hospitals. There are also limitations comparing risk-adjusted outcomes between hospitals. We sought to ascertain the effect of credentialing hospitals for PCR, either on the basis of procedural volume or outcome, on clinical outcome, cost and accessibility to treatment, in states of varied population density. Methods. We evaluated Medicare administrative data sets for all PCRs performed in 9 states during 1994-1995. Based upon volume- and risk-adjusted in-hospital mortality during 1994, hospitals were "accreddted" using varying volume and outcome thresholds, and the effect of accreditation using these thresholds was ascertained by analysis of 1995 outcomes. Sensitivity analyses were performed to assess the effect of altered assumptions. Results. During 1994, one hundred and thirty-three hospitals performed 34,879 PCRs in Medicare patients, with an overall mortality of 1.36%. If credentialing were performed based upon 1994 volumes, a sizable clinical benefitcould be expected only if large numbers of catheterization laboratories were "closed", e.g., if laboratories with < 200-300 Medicare cases/year (< 400-900 total cases) were "closed", mortality would be expected to decrease to 0.17-1.07% (maximum and minimum effect). Costs could be minimized by closing laboratories with < 100 Medicare cases/year (best case scenario, $512-$905/patient). Such laboratory closures would require transfer to hospitals > 50 miles distant in 6-38% of patients, but as many as 18-94% of patients in low-density states. If credentialing were done on the basis of 1994 adjusted mortality, a somewhat lesser reduction of risk of death (best case scenario, 0.93%), but little improvement in cost, could be expected. Conclusions. If generalizable, these data suggest that to achieve a sizable reduction in procedure-related mortality by hospital-based credentialing,large numbers of catheterization laboratories would need to be closed and patient access to care would be adversely impacted. Cost savings of a very considerable magnitude may be more readily achieved.

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Documento generato il 29/03/20 alle ore 01:13:02