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Do specialty heart hospitals drive up heart care use? Study suggests the answer is yes

o be planned around the country, often spurring debate in local areas.

The new study used Medicare data from 1995 to 2003, and focused on heart hospitals that offered bypass surgery or percutaneous coronary intervention (PCI, which includes angioplasty, stenting and related procedures). The researchers analyzed patterns of use for these procedures within 306 hospital referral regions or HRRs, which represent unique hospital markets for specialized care. After identifying 13 HRRs where one or more specialty cardiac hospital opened during the study period, the team calculated population-based rates for each year across the United States.

In every region, the use of PCI rose steadily over the time period, and the use of bypass surgery was level in the 1990s and declined in the early 2000s reflecting a well-known national trend toward minimally invasive techniques instead of surgery to reopen clogged heart arteries. In that same time period, many general hospitals began to offer PCI for the first time.

But the use for these procedures rose faster in the HRRs where a specialty cardiac hospital opened. Four years after the specialty cardiac hospitals opened, the population-adjusted rates of heart procedures in their surrounding HRRs had grown by more than twice as much as the rates in HRRs where no specialty hospital had opened. There was no major difference in those rates when the researchers compared HRRs where a new heart program had begun at a general hospital, and HRRs where no new heart services launched.

When the researchers separated the bypass surgery numbers from the angioplasty and other PCI numbers, they found the same effect. And when they considered post-heart attack emergency PCI rates with PCI rates for patients who had not had a heart attack, the difference was much greater. In regions where specialty heart hospitals opened, the rate of these "non-emergent" PCI procedures rose 42 percent in four years, compared
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Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
6-Mar-2007


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