Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Limiting Angioplasty to Experienced Hospitals Will Not Reduce Access to Care

13.10.2004


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 Duke’s 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 study’s first author Susan Kansagra of Duke. "Accordingly, patient outcomes could be improved by requiring hospitals and physicians to meet minimum standards."


"Our findings suggest that limiting angioplasty to higher-volume hospitals would not increase travel distances for most patients," added Lesley Curtis, Ph.D., a member of the Duke Center for Clinical and Genetic Economics, who also contributed to the research. However, they caution that other potential costs of restricting angioplasty to more experienced centers -- such as possible effects on the ability of smaller hospitals to provide other healthcare services -- must be examined before recommending such a policy.

The researchers examined hospital discharge records for 97,401 patients who underwent angioplasty in New York, New Jersey and Florida in 2001. For each patient, the team approximated travel distances to area hospitals as the distance between their home and hospital zip code areas.

Eighty-seven percent of patients would have traveled approximately the same distance to the nearest eligible hospital, if a minimum volume standard of 75 angioplasty procedures per physician and 400 per hospital had been in effect, as recommended by the ACC, the researchers found. Two percent of patients would have traveled farther to reach an angioplasty facility and 11 percent would have traveled a shorter distance.

With a stricter minimum volume standard of 175 angioplasties per physician and 400 per hospital, 25 percent of patients would have traveled a shorter distance to the hospital and ten percent a longer distance. The remaining 65 percent of patients would have experienced no change in travel distance to the nearest qualifying facility, the team reported. Most patients with longer travel distances under such a strict standard would travel no more than 25 miles farther to reach the nearest high volume hospital, they found.

Under either standard, less than one percent of patients would travel more than 50 miles farther than their observed travel distance, they found. "One argument against regionalizing healthcare based on minimum volume standards has been the limitations it might impose on access to care for patients living in more remote areas," Kansagra said. "Our study suggests angioplasty standards could be put in place with minor consequences for patient travel."

The only other studies known to address the impact of minimum volume standards on travel distances -- all for procedures less common than angioplasty, including pancreas and esophagus removal, coronary bypass surgery and pediatric heart surgery -- have reported small increases in travel distance or time for the majority of patients, she said.

Kendall Morgan | EurekAlert!
Further information:
http://www.dukemednews.org
http://www.duke.edu

More articles from Health and Medicine:

nachricht Laser activated gold pyramids could deliver drugs, DNA into cells without harm
24.03.2017 | Harvard John A. Paulson School of Engineering and Applied Sciences

nachricht What does congenital Zika syndrome look like?
24.03.2017 | University of California - San Diego

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Giant Magnetic Fields in the Universe

Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.

The results will be published on March 22 in the journal „Astronomy & Astrophysics“.

Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...

Im Focus: Tracing down linear ubiquitination

Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.

Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...

Im Focus: Perovskite edges can be tuned for optoelectronic performance

Layered 2D material improves efficiency for solar cells and LEDs

In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...

Im Focus: Polymer-coated silicon nanosheets as alternative to graphene: A perfect team for nanoelectronics

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...

Im Focus: Researchers Imitate Molecular Crowding in Cells

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to simulate these confined natural conditions in artificial vesicles for the first time. As reported in the academic journal Small, the results are offering better insight into the development of nanoreactors and artificial organelles.

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

International Land Use Symposium ILUS 2017: Call for Abstracts and Registration open

20.03.2017 | Event News

CONNECT 2017: International congress on connective tissue

14.03.2017 | Event News

ICTM Conference: Turbine Construction between Big Data and Additive Manufacturing

07.03.2017 | Event News

 
Latest News

Argon is not the 'dope' for metallic hydrogen

24.03.2017 | Materials Sciences

Astronomers find unexpected, dust-obscured star formation in distant galaxy

24.03.2017 | Physics and Astronomy

Gravitational wave kicks monster black hole out of galactic core

24.03.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>