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

其他项目信息-项目摘要/摘要 经皮冠状动脉介入治疗室的开闭对患者、医院和社区的影响 获得心脏技术，如经皮冠状动脉介入(PCI)实验室，对于 改善人口健康状况。然而，我们和其他人已经证明，PCI实验室的激增往往会 集中在富裕社区，不合时宜的获取往往集中在低收入群体 社区。这种跨社区的差异化扩散和封闭模式可能会扩大 弱势社区与其他社区之间的差距。此外，PCI实验室的激增可能会 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，这可能会导致更糟糕的结果。 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和 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，冠状动脉介入治疗设施的不均衡增殖和关闭 通过以下途径影响人口健康：(1)在社区一级，它们造成差距扩大 在已经具有较高PCI容量的社区和仍具有较高PCI容量的社区之间进行资源分配 未得到满足的需求；(2)在医院层面，他们改变经皮冠状动脉介入治疗容量的方式可能会导致健康状况恶化 有心脏疾病的患者的结果；以及(3)在个体患者层面，它们重新分配患者 并扩大弱势患者与其他患者在获取、治疗和健康结果方面的差距。目标1和 2说明不同情况(急性心肌梗死和急性心肌梗死)患者更改PCI实验室访问权限的平均效果 稳定的CAD)，而Aim 3解决了弱势群体和其他群体之间的差异效应。 我们将链接几个主要的数据库来解决我们的研究问题。首先，使用的主要数据 我们将确定患者群体将是100%的医疗保险提供者和分析审查以及B部分索赔 在2005至2014年间。其次，我们将使用的主要数据源确定PCI实验室可用性 美国医院协会(AHA)同年进行的年度调查。第三，我们已经获得了初选 从AHA调查和医疗成本报告中确定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构成，以及用于获取额外健康状况的区域资源文件 关心县级市场资源。最后，我们将推导出识别(1)基准PCI的两个数据库 每个社区的容量和(2)每个患者的邮政编码和相应驾驶的最近的PCI实验室 时间到了。通过提供直接证据表明冠状动脉介入治疗的改变如何影响急性心肌梗死患者的健康结局 和稳定的冠心病在不同的社区，这项研究将告知政策制定者冠状动脉介入治疗的影响 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.