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The Impact of Service Availability on Service Use in New York State

Jan Blustein, MD, PhD

JAMA. 1993;270(3):344-349.

Abstract
Objective.
—To study the impact of the in-hospital availability of three cardiac procedures (cardiac catheterization, bypass surgery, and angioplasty) on their use in patients during the period following acute myocardial infarction (AMI).

Design.
—Retrospective cohort study, based on a statewide hospital discharge abstract data set.

Participants.
—Patients admitted with a principal diagnosis of AMI to New York State hospitals during March through June of 1986.

Main Outcome Measures.
—The odds of utilizing each of the three services either during the initial admission for AMI or during the 6-month postdischarge interval. Odds ratios (ORs) were calculated comparing utilization in three groups of patients: those initially presenting to hospitals lacking all three services, those initially presenting to hospitals offering only cardiac catheterization, and those initially presenting to hospitals offering all three of the cardiac services. Odds were adjusted for age, sex, race, income, primary payer, severity of illness, and geographical distance to hospital.

Results.
—Relative to patients initially presenting to hospitals lacking all three services, patients initially presenting to hospitals offering only cardiac catheterization were more likely to undergo cardiac catheterization (OR, 3.57; 95% confidence interval [Cl], 3.03 to 4.22), but were not significantly more likely to undergo bypass surgery or angioplasty. Relative to patients initially presenting to hospitals lacking all three services, patients initially presenting to hospitals offering all three services were more likely to undergo cardiac catheterization (OR, 5.50; 95% Cl, 4.66 to 6.50), bypass surgery (OR, 2.52; 95% Cl, 1.95 to 3.24), and angioplasty (OR, 6.85; 95% Cl, 4.73 to 10.58).

Conclusions.
—The availability of cardiac services in the hospital to which patients initially present strongly influences the likelihood of their use in the period following AMI.

(JAMA. 1993;270:344-349)

Author Affiliations
From the Health Research Program, Wagner Graduate School, New York (NY) University.

Footnotes
Reprint requests to Wagner Graduate School, New York University, 329 Shimkin Hall, 50 W Fourth St, New York, NY 10003 (Dr Blustein).

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