Standards of volume that limit angioplasty procedures to more experienced hospitals and physicians will not require most patients to travel longer distances for care, according to a new study by researchers at Duke University Medical Center and Dukes Fuqua School of Business. The findings should allay concerns about the effects of such standards on access to care for heart patients living in rural or remote areas, the researchers said.
Angioplasty opens coronary arteries clogged by fatty plaques, using a balloon at the tip of a catheter to press the plaque against the artery wall. In some cases, a stent helps keep the artery open. Earlier studies have found that patients receiving angioplasty treatment at higher-volume hospitals have better outcomes than those at smaller or less experienced hospitals, said Kevin Schulman, M.D., director of the Duke Center for Clinical and Genetic Economics and of the Health Sector Management Program at Fuqua. The American College of Cardiology (ACC) therefore recommends that hospitals perform at least 400 angioplasty procedures annually and that practicing physicians perform at least 75 procedures annually.
For the vast majority of patients, travel distances would remain unchanged should those receiving care at low-volume hospitals be diverted to facilities that meet such minimum requirements, the team reported in the Oct. 13, 2004, Journal of the American Medical Association (JAMA). "At operator and hospital levels, higher procedure volume is associated with lower rates of inpatient mortality, emergency bypass surgery and complications," said the studys first author Susan Kansagra of Duke. "Accordingly, patient outcomes could be improved by requiring hospitals and physicians to meet minimum standards."
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