Cargando…
Impact of service redesign on the socioeconomic inequity in revascularisation rates for patients with acute myocardial infarction: a natural experiment and electronic record-linked cohort study
AIM: To investigate the impact of service redesign in the provision of revascularisation procedures on the historical socioeconomic inequity in revascularisation rates for patients with acute myocardial infarction (AMI). DESIGN: Natural experiment and retrospective cohort study using linked data set...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5093375/ https://www.ncbi.nlm.nih.gov/pubmed/27797993 http://dx.doi.org/10.1136/bmjopen-2016-011656 |
_version_ | 1782464906907353088 |
---|---|
author | Evans, Lloyd W van Woerden, Hugo Davies, Gareth R Fone, David |
author_facet | Evans, Lloyd W van Woerden, Hugo Davies, Gareth R Fone, David |
author_sort | Evans, Lloyd W |
collection | PubMed |
description | AIM: To investigate the impact of service redesign in the provision of revascularisation procedures on the historical socioeconomic inequity in revascularisation rates for patients with acute myocardial infarction (AMI). DESIGN: Natural experiment and retrospective cohort study using linked data sets in the Secure Anonymised Information Linkage databank. NON-RANDOMISED INTERVENTION: An increase in the capacity of revascularisation procedures and service redesign in the provision of revascularisation in late 2011 to early 2012. SETTING: South Wales cardiac network, Census 2011 population 1 359 051 aged 35 years and over. PARTICIPANTS: 9128 participants admitted to an NHS hospital with a first AMI between 1 January 2010 and 30 June 2013, with 6-months follow-up. MAIN OUTCOME MEASURE: Hazard ratios (HRs) for the time to revascularisation for deprivation quintiles, age, gender, comorbidities, rural–urban classification and revascularisation facilities of admitting hospital. RESULTS: In the preintervention period, there was a statistically significant decreased adjusted risk of revascularisation for participants in the most deprived quintile compared to the least deprived quintile (HR 0.80; 95% CI 0.69 to 0.92, p=0.002). In the postintervention period, the increase in revascularisation rates was statistically significant in all quintiles, and there was no longer any statistically significant difference in the adjusted revascularisation risk between the most and the least deprived quintile (HR 1.04; 95% CI 0.89 to 1.20, p<0.649). However, inequity persisted for those aged 75 years and over (HR 0.40; 95% CI 0.35 to 0.46, p<0.001) and women (HR 0.77; 95% CI 0.70 to 0.86, p<0.001). CONCLUSIONS: Socioeconomic inequity of access to revascularisation was no longer apparent following redesign of revascularisation services in the south Wales cardiac network, although inequity persisted for women and those aged 75+ years. Increasing the capacity of revascularisation did not differentially benefit participants from the least deprived areas. |
format | Online Article Text |
id | pubmed-5093375 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-50933752016-11-14 Impact of service redesign on the socioeconomic inequity in revascularisation rates for patients with acute myocardial infarction: a natural experiment and electronic record-linked cohort study Evans, Lloyd W van Woerden, Hugo Davies, Gareth R Fone, David BMJ Open Cardiovascular Medicine AIM: To investigate the impact of service redesign in the provision of revascularisation procedures on the historical socioeconomic inequity in revascularisation rates for patients with acute myocardial infarction (AMI). DESIGN: Natural experiment and retrospective cohort study using linked data sets in the Secure Anonymised Information Linkage databank. NON-RANDOMISED INTERVENTION: An increase in the capacity of revascularisation procedures and service redesign in the provision of revascularisation in late 2011 to early 2012. SETTING: South Wales cardiac network, Census 2011 population 1 359 051 aged 35 years and over. PARTICIPANTS: 9128 participants admitted to an NHS hospital with a first AMI between 1 January 2010 and 30 June 2013, with 6-months follow-up. MAIN OUTCOME MEASURE: Hazard ratios (HRs) for the time to revascularisation for deprivation quintiles, age, gender, comorbidities, rural–urban classification and revascularisation facilities of admitting hospital. RESULTS: In the preintervention period, there was a statistically significant decreased adjusted risk of revascularisation for participants in the most deprived quintile compared to the least deprived quintile (HR 0.80; 95% CI 0.69 to 0.92, p=0.002). In the postintervention period, the increase in revascularisation rates was statistically significant in all quintiles, and there was no longer any statistically significant difference in the adjusted revascularisation risk between the most and the least deprived quintile (HR 1.04; 95% CI 0.89 to 1.20, p<0.649). However, inequity persisted for those aged 75 years and over (HR 0.40; 95% CI 0.35 to 0.46, p<0.001) and women (HR 0.77; 95% CI 0.70 to 0.86, p<0.001). CONCLUSIONS: Socioeconomic inequity of access to revascularisation was no longer apparent following redesign of revascularisation services in the south Wales cardiac network, although inequity persisted for women and those aged 75+ years. Increasing the capacity of revascularisation did not differentially benefit participants from the least deprived areas. BMJ Publishing Group 2016-10-24 /pmc/articles/PMC5093375/ /pubmed/27797993 http://dx.doi.org/10.1136/bmjopen-2016-011656 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Cardiovascular Medicine Evans, Lloyd W van Woerden, Hugo Davies, Gareth R Fone, David Impact of service redesign on the socioeconomic inequity in revascularisation rates for patients with acute myocardial infarction: a natural experiment and electronic record-linked cohort study |
title | Impact of service redesign on the socioeconomic inequity in revascularisation rates for patients with acute myocardial infarction: a natural experiment and electronic record-linked cohort study |
title_full | Impact of service redesign on the socioeconomic inequity in revascularisation rates for patients with acute myocardial infarction: a natural experiment and electronic record-linked cohort study |
title_fullStr | Impact of service redesign on the socioeconomic inequity in revascularisation rates for patients with acute myocardial infarction: a natural experiment and electronic record-linked cohort study |
title_full_unstemmed | Impact of service redesign on the socioeconomic inequity in revascularisation rates for patients with acute myocardial infarction: a natural experiment and electronic record-linked cohort study |
title_short | Impact of service redesign on the socioeconomic inequity in revascularisation rates for patients with acute myocardial infarction: a natural experiment and electronic record-linked cohort study |
title_sort | impact of service redesign on the socioeconomic inequity in revascularisation rates for patients with acute myocardial infarction: a natural experiment and electronic record-linked cohort study |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5093375/ https://www.ncbi.nlm.nih.gov/pubmed/27797993 http://dx.doi.org/10.1136/bmjopen-2016-011656 |
work_keys_str_mv | AT evanslloydw impactofserviceredesignonthesocioeconomicinequityinrevascularisationratesforpatientswithacutemyocardialinfarctionanaturalexperimentandelectronicrecordlinkedcohortstudy AT vanwoerdenhugo impactofserviceredesignonthesocioeconomicinequityinrevascularisationratesforpatientswithacutemyocardialinfarctionanaturalexperimentandelectronicrecordlinkedcohortstudy AT daviesgarethr impactofserviceredesignonthesocioeconomicinequityinrevascularisationratesforpatientswithacutemyocardialinfarctionanaturalexperimentandelectronicrecordlinkedcohortstudy AT fonedavid impactofserviceredesignonthesocioeconomicinequityinrevascularisationratesforpatientswithacutemyocardialinfarctionanaturalexperimentandelectronicrecordlinkedcohortstudy |