Effects of Percutaneous Coronary Intervention Lab Openings and Closures on Patients, Hospitals, and Communities

其他项目信息-项目概要/摘要 经皮冠状动脉介入治疗实验室开放和关闭对患者、医院和社区的影响 获得心脏技术，如经皮冠状动脉介入治疗（PCI）实验室， 改善人口健康。然而，我们和其他人已经证明，PCI实验室的扩散往往 集中在富裕社区，而不及时获得往往集中在低收入社区， 社区.社区之间这种不同的扩散和封闭模式可能会扩大 弱势群体与其他群体之间的差距。此外，PCI实验室的激增可能 导致在每个站点执行的程序更少，特别是在已经具有高PCI容量的市场中， 基线，这可能导致更糟糕的结果。 我们的主要目标是确定PCI实验室的开放和关闭如何影响资源分配， 饱和和低容量市场中的患者健康，以及这些市场活动是否不成比例 影响弱势群体。我们的中心假设是，PCI设施的不均衡扩散和关闭 通过以下途径影响人口健康：（1）在社区一级，它们导致差距扩大 在已经具有高PCI能力和仍然具有高PCI能力社区之间的资源分配中， 未满足的需求;（2）在医院层面，他们改变PCI量的方式可能导致健康状况恶化 心脏病患者的预后;（3）在个体患者层面， 并扩大弱势患者和其他患者之间在获取、治疗和健康结果方面的差距。目标1和 2解决PCI实验室访问变化对不同条件患者（AMI和 目标3涉及弱势群体和其他群体之间的差别影响。 我们将链接几个主要的数据库来解决我们的研究问题。第一，主要数据， 我们将确定患者队列为100% Medicare提供者，并进行分析审查和B部分索赔 在2005年到2014年间。其次，我们将使用PCI实验室的主要数据源来确定PCI实验室的可用性， 美国医院协会（AHA）同年的年度调查。第三，我们获得了初级 从AHA调查和医疗保健成本报告中识别其他医院特征的数据 信息系统第四，我们将使用2010年美国人口普查和美国社区调查来确定每一个 邮政编码社区的人口统计组成，以及用于捕获其他健康状况的区域资源文件 县级市场资源。最后，我们将得出两个数据库，确定（1）基线PCI 每个社区的容量，以及（2）每个患者的邮政编码和相应驾驶的最近PCI实验室 时间通过提供直接证据证明PCI通路的变化如何影响AMI患者的健康结局 和稳定的CAD在不同的社区，这项研究将告知决策者的影响，PCI 社区、医院和个人层面的扩散和关闭。

OTHER PROJECT INFORMATION – Project Summary/Abstract Effects of Percutaneous Coronary Intervention Lab Openings & Closures on Patients, Hospitals &Communities Access to cardiac technology such as percutaneous coronary intervention (PCI) labs is critical to improving population health. Yet we and others have documented that the proliferation of PCI labs tends to concentrate among affluent communities, and untimely access tends to concentrate among low-income communities. Such differential diffusion and closure patterns across communities may widen gaps in disparities between vulnerable communities and other communities. Moreover, proliferation of PCI labs might lead to fewer procedures performed at each site, especially in markets that already have high PCI capacity at baseline, which could lead to worse outcomes. Our primary goal is to identify how openings and closures of PCI labs affect resource allocation and patient health in saturated and low-capacity markets, and whether these market activities disproportionately affect vulnerable populations. Our central hypothesis is that uneven proliferation and closures of PCI facilities affects population health through the following pathways: (1) at the community level, they cause widening gaps in resource allocation between communities that already have high PCI capacity and those that still have unmet need; (2) at the hospital level, they change PCI volume in such a way that could result in worse health outcomes for patients with cardiac conditions; and (3) at the individual patient level, they redistribute patients and widen gaps in access, treatment, and health outcomes between vulnerable and other patients. Aims 1 and 2 address the average effect of PCI lab access change among patients with different conditions (AMI and stable CAD), while Aim 3 addresses the differential effect between vulnerable and other groups. We will link several major databases to address our research questions. First, the primary data with which we will identify the patient cohort will be the 100% Medicare Provider and Analysis Review and Part B claims between 2005 and 2014. Second, we will identify PCI lab availability using the primary data source of the American Hospital Association (AHA) annual surveys for the same years. Third, we have obtained primary data to identify additional hospital characteristics from the AHA surveys and the Healthcare Cost Report Information System. Fourth, we will use 2010 U.S. Census and American Community Surveys to identify each ZIP code community's demographic composition, and the Area Resource File for capturing additional health care market resources at the county level. Last, we will derive two databases that identify (1) baseline PCI capacity for each community and (2) the nearest PCI lab for each patient's ZIP code and corresponding driving time. By providing direct evidence of how changes in PCI access affect health outcomes of patients with AMI and stable CAD in different communities, this research will inform policymakers about the implications of PCI proliferation and closures at community, hospital, and individual levels.