JAMA
1993 Jul 21;270(3):344-9
High-technology cardiac procedures. The impact of service availability
on service use in New York State.
Blustein J.
Health Research Program, Wagner Graduate School, New York University,
NY.
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.
PMID: 8315778 [PubMed - indexed for MEDLINE]
