Document Detail

Shifts in surgical revascularization and valve procedures among Medicare beneficiaries.
MedLine Citation:
PMID:  21642877     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The rapid development of percutaneous coronary intervention (PCI) has reduced the demand for coronary artery bypass grafting (CABG) surgery. We examined whether the previously documented declining demand for CABG and expanding PCI use are associated with changes in performance of valve (aortic or mitral) replacement or repair surgery.
METHODS: We used Medicare Part A administrative data to identify beneficiaries who received PCI, CABG, valve procedures between 1991 and 2005. We used multivariable models to investigate the relationship between CABG and PCI rates and rates of aortic and mitral valve surgery at the hospital referral region level while adjusting for demand and supply factors including heart disease rates.
RESULTS: Hospital referral region level rates of valve replacement and repair increased by 0.36 and 0.17 per 1000. A 1 per 1000 change in the isolated CABG rates was positively associated with a 0.0255 and 0.0013 per 1000 change in the concomitant (simultaneous CABG) valve replacement and repair rates. A 1 per 1000 change in the PCI rate was positively associated with 0.0105 and a 0.0051 per 1000 change in the concomitant valve replacement and repair rate. A 1 per 1000 change in the isolated CABG rates was positively associated with a 0.0151 per thousand isolated valve replacement and negatively associated with a 0.0013 per 1000 repair rate. A 1 per 1000 change in the PCI rate was positively associated with a 0.0081 and a 0.0031 per 1000 change in the isolated valve replacement and repair rate.
CONCLUSIONS: A modest portion of the change in valve replacement and repair use over the period is associated with shifts in revascularization. Future study needs to consider the effects of these trends on patient outcomes and resource use.
Jason Hockenberry; Xin Lu; Mary S Vaughan-Sarrazin; Stephen Snyder; Eric Peterson; Peter Cram
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Medical care     Volume:  49     ISSN:  1537-1948     ISO Abbreviation:  Med Care     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-07-15     Completed Date:  2011-09-23     Revised Date:  2014-09-10    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  686-92     Citation Subset:  IM    
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MeSH Terms
Aortic Valve / surgery
Coronary Artery Bypass / statistics & numerical data*
Health Services Research
Heart Valve Diseases / surgery*
Linear Models
Medicare / statistics & numerical data*
Mitral Valve / surgery
Physician's Practice Patterns / statistics & numerical data*
Referral and Consultation / statistics & numerical data
United States
Vascular Surgical Procedures / statistics & numerical data*
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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