Certificate of Need and Cardiac Outcomes

描述（由申请人提供）：该修订提案来自一名新的研究者，旨在确定国家需求证明（CON）法规是否会改善接受冠状动脉搭桥手术（CABG）或经皮腔内冠状动脉成形术（PTCA）的患者的预后。初步证据表明，CON法律与CABG和PTCA的医院手术量增加有关。鉴于医学文献中较高的医院容量与较好的预后相关，CON定律可能导致CABG和PTCA的预后改善。本提案将通过结合医疗保险索赔数据和其他信息来源来验证这一假设，以回答以下问题：(1)CON法规增加了多少CABG和PTCA的平均医院容量？(2) CON监管在小容量医院减少治疗的概率有多大？(3)与CON法规相关的医院容量增加是否会改善接受CABG和PTCA的患者的预后？(4)在控制了潜在的体积效应后，CON法规是否对患者预后有任何额外的影响？(5) CON法规是否降低了每位患者进行CABG和PTCA的平均成本？(6) CON法规是否导致接受CABG和PTCA的患者总数增加？这一分析的结果对评估在提高病人护理质量的调节作用具有重要意义。几个州已经放弃了心脏护理的CON规定，其他州正在讨论是否要维持他们的CON项目。然而，美国法律通过对医疗服务提供者实施最低数量标准来提高医疗质量的能力，从未通过比较几个州的数据得到检验。如果与CON法规相关的容量增加确实改善了患者的预后，那么应该重新审视放松CON法规的总体趋势。

DESCRIPTION (provided by applicant): This revised proposal from a new investigator seeks to determine whether state Certificate of Need (CON) regulations lead to improved outcomes for patients who receive coronary artery bypass surgery (CABG) or percutaneous transluminal coronary angioplasty (PTCA). Preliminary evidence suggests that CON laws are associated with higher hospital procedure volume for both CABG and PTCA. Given that higher hospital volume has been associated with better outcomes in the medical literature, CON laws may lead to improved outcomes for CABG and PTCA. This proposal will test this hypothesis by combining Medicare claims data with other information sources to answer the following questions: (1) How much does CON regulation increase the average hospital volume for CABG and PTCA? (2) How much does CON regulation reduce the probability of treatment in a low-volume hospital? (3) Does the increased hospital volume associated with the CON regulations lead to improved outcomes for patients receiving CABG and PTCA? (4) Do CON regulations have any additional impact on patient outcomes after controlling for their potential volume effect? (5) Do CON regulations lower the average cost per patient for performing CABG and PTCA? (6) Do CON regulations lead to overall increases in the number of patients receiving CABG and PTCA? The results of this analysis have important implications for assessing the role of regulation in improving the quality of patient care. Several states have dropped CON regulations for cardiac care, and others are debating whether to maintain their CON programs. Yet the ability of CON laws to improve quality by imposing minimum volume standards for providers has never been tested by comparing data across several states. If volume increases associated with CON laws do in fact improve patient outcomes, then the general trend towards relaxing CON regulations should be revisited.