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 Usher syndrome: Gene therapy restores hearing and balance
25.09.2017 | Institut Pasteur

nachricht MRI contrast agent locates and distinguishes aggressive from slow-growing breast cancer
25.09.2017 | Case Western Reserve University

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: LaserTAB: More efficient and precise contacts thanks to human-robot collaboration

At the productronica trade fair in Munich this November, the Fraunhofer Institute for Laser Technology ILT will be presenting Laser-Based Tape-Automated Bonding, LaserTAB for short. The experts from Aachen will be demonstrating how new battery cells and power electronics can be micro-welded more efficiently and precisely than ever before thanks to new optics and robot support.

Fraunhofer ILT from Aachen relies on a clever combination of robotics and a laser scanner with new optics as well as process monitoring, which it has developed...

Im Focus: The pyrenoid is a carbon-fixing liquid droplet

Plants and algae use the enzyme Rubisco to fix carbon dioxide, removing it from the atmosphere and converting it into biomass. Algae have figured out a way to increase the efficiency of carbon fixation. They gather most of their Rubisco into a ball-shaped microcompartment called the pyrenoid, which they flood with a high local concentration of carbon dioxide. A team of scientists at Princeton University, the Carnegie Institution for Science, Stanford University and the Max Plank Institute of Biochemistry have unravelled the mysteries of how the pyrenoid is assembled. These insights can help to engineer crops that remove more carbon dioxide from the atmosphere while producing more food.

A warming planet

Im Focus: Highly precise wiring in the Cerebral Cortex

Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.

The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...

Im Focus: Tiny lasers from a gallery of whispers

New technique promises tunable laser devices

Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

“Lasers in Composites Symposium” in Aachen – from Science to Application

19.09.2017 | Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

 
Latest News

Fraunhofer ISE Pushes World Record for Multicrystalline Silicon Solar Cells to 22.3 Percent

25.09.2017 | Power and Electrical Engineering

Usher syndrome: Gene therapy restores hearing and balance

25.09.2017 | Health and Medicine

An international team of physicists a coherent amplification effect in laser excited dielectrics

25.09.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>