Cargando…

Association of Statewide Certificate of Need Regulations With Percutaneous Coronary Intervention Appropriateness and Outcomes

BACKGROUND: Certificate of need (CON) regulations are intended to coordinate new healthcare services, limit expansion of unnecessary new infrastructure, and limit healthcare costs. However, there is limited information about the association of CON regulations with the appropriateness and outcomes of...

Descripción completa

Detalles Bibliográficos
Autores principales: Chui, Philip W., Parzynski, Craig S., Ross, Joseph S., Desai, Nihar R., Gurm, Hitinder S., Spertus, John A., Seto, Arnold H., Ho, Vivian, Curtis, Jeptha P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497347/
https://www.ncbi.nlm.nih.gov/pubmed/30642222
http://dx.doi.org/10.1161/JAHA.118.010373
_version_ 1783415458193473536
author Chui, Philip W.
Parzynski, Craig S.
Ross, Joseph S.
Desai, Nihar R.
Gurm, Hitinder S.
Spertus, John A.
Seto, Arnold H.
Ho, Vivian
Curtis, Jeptha P.
author_facet Chui, Philip W.
Parzynski, Craig S.
Ross, Joseph S.
Desai, Nihar R.
Gurm, Hitinder S.
Spertus, John A.
Seto, Arnold H.
Ho, Vivian
Curtis, Jeptha P.
author_sort Chui, Philip W.
collection PubMed
description BACKGROUND: Certificate of need (CON) regulations are intended to coordinate new healthcare services, limit expansion of unnecessary new infrastructure, and limit healthcare costs. However, there is limited information about the association of CON regulations with the appropriateness and outcomes of percutaneous coronary interventions (PCI). The study sought to characterize the association between state CON regulations and PCI appropriateness. METHODS AND RESULTS: We used data from the American College of Cardiology's CathPCI Registry to analyze 1 268 554 PCIs performed at 1297 hospitals between January 2010 and December 2011. We used the Appropriate Use Criteria to classify PCI procedures as appropriate, maybe appropriate, or rarely appropriate and used Chi‐square analyses to assess whether the proportions of PCIs in each Appropriate Use Criteria category varied depending on whether the procedure had been performed in a state with or without CON regulations. Analyses were repeated stratified by whether or not the procedure had been performed in the setting of an acute coronary syndrome (ACS). Among 1 268 554 PCI procedures, 674 384 (53.2%) were performed within 26 CON states. The proportion of PCIs classified as rarely appropriate in CON states was slightly lower compared with non‐CON states (3.7% versus 4.0%, P<0.01). Absolute differences were larger among non‐ACS PCI (23.1% versus 25.0% [P<0.01]) and were not statistically significantly different in ACS (0.62% versus 0.63% [P>0.05]). CONCLUSIONS: States with CON had lower proportions of rarely appropriate PCIs, but the absolute differences were small. These findings suggest that CON regulations alone may not limit rarely appropriate PCI among patients with and without ACS.
format Online
Article
Text
id pubmed-6497347
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-64973472019-05-07 Association of Statewide Certificate of Need Regulations With Percutaneous Coronary Intervention Appropriateness and Outcomes Chui, Philip W. Parzynski, Craig S. Ross, Joseph S. Desai, Nihar R. Gurm, Hitinder S. Spertus, John A. Seto, Arnold H. Ho, Vivian Curtis, Jeptha P. J Am Heart Assoc Original Research BACKGROUND: Certificate of need (CON) regulations are intended to coordinate new healthcare services, limit expansion of unnecessary new infrastructure, and limit healthcare costs. However, there is limited information about the association of CON regulations with the appropriateness and outcomes of percutaneous coronary interventions (PCI). The study sought to characterize the association between state CON regulations and PCI appropriateness. METHODS AND RESULTS: We used data from the American College of Cardiology's CathPCI Registry to analyze 1 268 554 PCIs performed at 1297 hospitals between January 2010 and December 2011. We used the Appropriate Use Criteria to classify PCI procedures as appropriate, maybe appropriate, or rarely appropriate and used Chi‐square analyses to assess whether the proportions of PCIs in each Appropriate Use Criteria category varied depending on whether the procedure had been performed in a state with or without CON regulations. Analyses were repeated stratified by whether or not the procedure had been performed in the setting of an acute coronary syndrome (ACS). Among 1 268 554 PCI procedures, 674 384 (53.2%) were performed within 26 CON states. The proportion of PCIs classified as rarely appropriate in CON states was slightly lower compared with non‐CON states (3.7% versus 4.0%, P<0.01). Absolute differences were larger among non‐ACS PCI (23.1% versus 25.0% [P<0.01]) and were not statistically significantly different in ACS (0.62% versus 0.63% [P>0.05]). CONCLUSIONS: States with CON had lower proportions of rarely appropriate PCIs, but the absolute differences were small. These findings suggest that CON regulations alone may not limit rarely appropriate PCI among patients with and without ACS. John Wiley and Sons Inc. 2019-01-15 /pmc/articles/PMC6497347/ /pubmed/30642222 http://dx.doi.org/10.1161/JAHA.118.010373 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Chui, Philip W.
Parzynski, Craig S.
Ross, Joseph S.
Desai, Nihar R.
Gurm, Hitinder S.
Spertus, John A.
Seto, Arnold H.
Ho, Vivian
Curtis, Jeptha P.
Association of Statewide Certificate of Need Regulations With Percutaneous Coronary Intervention Appropriateness and Outcomes
title Association of Statewide Certificate of Need Regulations With Percutaneous Coronary Intervention Appropriateness and Outcomes
title_full Association of Statewide Certificate of Need Regulations With Percutaneous Coronary Intervention Appropriateness and Outcomes
title_fullStr Association of Statewide Certificate of Need Regulations With Percutaneous Coronary Intervention Appropriateness and Outcomes
title_full_unstemmed Association of Statewide Certificate of Need Regulations With Percutaneous Coronary Intervention Appropriateness and Outcomes
title_short Association of Statewide Certificate of Need Regulations With Percutaneous Coronary Intervention Appropriateness and Outcomes
title_sort association of statewide certificate of need regulations with percutaneous coronary intervention appropriateness and outcomes
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497347/
https://www.ncbi.nlm.nih.gov/pubmed/30642222
http://dx.doi.org/10.1161/JAHA.118.010373
work_keys_str_mv AT chuiphilipw associationofstatewidecertificateofneedregulationswithpercutaneouscoronaryinterventionappropriatenessandoutcomes
AT parzynskicraigs associationofstatewidecertificateofneedregulationswithpercutaneouscoronaryinterventionappropriatenessandoutcomes
AT rossjosephs associationofstatewidecertificateofneedregulationswithpercutaneouscoronaryinterventionappropriatenessandoutcomes
AT desainiharr associationofstatewidecertificateofneedregulationswithpercutaneouscoronaryinterventionappropriatenessandoutcomes
AT gurmhitinders associationofstatewidecertificateofneedregulationswithpercutaneouscoronaryinterventionappropriatenessandoutcomes
AT spertusjohna associationofstatewidecertificateofneedregulationswithpercutaneouscoronaryinterventionappropriatenessandoutcomes
AT setoarnoldh associationofstatewidecertificateofneedregulationswithpercutaneouscoronaryinterventionappropriatenessandoutcomes
AT hovivian associationofstatewidecertificateofneedregulationswithpercutaneouscoronaryinterventionappropriatenessandoutcomes
AT curtisjepthap associationofstatewidecertificateofneedregulationswithpercutaneouscoronaryinterventionappropriatenessandoutcomes