Certificate of Need and Cardiac Outcomes

描述（由申请人提供）：这项来自新研究者的修订提案旨在确定州需要证明（CON）法规是否会改善接受冠状动脉旁路手术（CABG）或经皮腔内冠状动脉成形术（PTCA）的患者的结局。 初步证据表明，CON定律与CABG和PTCA的较高医院手术量相关。 鉴于在医学文献中，较高的住院量与较好的结局相关，CON法规可能会改善CABG和PTCA的结局。 本提案将通过将医疗保险索赔数据与其他信息来源相结合来验证这一假设，以回答以下问题：（1）CON法规使CABG和PTCA的平均住院量增加了多少？ (2)CON监管在多大程度上降低了低容量医院的治疗概率？ (3)与CON法规相关的医院容量增加是否会改善接受CABG和PTCA的患者的结局？ (4)在控制了潜在的体积效应后，CON法规是否对患者结局有任何额外的影响？ (5)CON法规是否降低了施行CABG和PTCA的每位患者的平均成本？ (6)CON法规是否会导致接受CABG和PTCA的患者数量总体增加？ 这项分析的结果有重要的影响，评估监管的作用，提高病人的护理质量。 几个州已经放弃了心脏护理的CON法规，其他州正在讨论是否维持他们的CON计划。 然而，CON法律通过对供应商实施最低数量标准来提高质量的能力从未通过比较几个州的数据进行过测试。 如果与CON法律相关的音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.