| Shifts in surgical revascularization and valve procedures among Medicare beneficiaries. | |
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MedLine Citation:
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PMID: 21642877 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Jason Hockenberry; Xin Lu; Mary S Vaughan-Sarrazin; Stephen Snyder; Eric Peterson; Peter Cram |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Medical care Volume: 49 ISSN: 1537-1948 ISO Abbreviation: Med Care Publication Date: 2011 Aug |
Date Detail:
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Created Date: 2011-07-15 Completed Date: 2011-09-23 Revised Date: 2012-02-22 |
Medline Journal Info:
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Nlm Unique ID: 0230027 Medline TA: Med Care Country: United States |
Other Details:
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Languages: eng Pagination: 686-92 Citation Subset: IM |
Affiliation:
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Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA 52242, USA. jason-hockenberry@uiowa.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aortic Valve / surgery Coronary Artery Bypass / statistics & numerical data* Female Health Services Research Heart Valve Diseases / surgery* Humans Linear Models Male 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 | |
ID/Acronym/Agency:
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R01 AG033035-03/AG/NIA NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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