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Regionalization of Percutaneous Transluminal Coronary Angioplasty and Implications for Patient Travel Distance
Susan M. Kansagra, BS;
Lesley H. Curtis, PhD;
Kevin A. Schulman, MD
JAMA. 2004;292:1717-1723.
Context Minimum procedure volume thresholds have been proposed to improve outcomes among patients undergoing percutaneous transluminal coronary angioplasty (PTCA). How regionalization policies would affect patient travel distances is not known.
Objective To examine the effect of regionalization of PTCA on patient travel distances.
Design, Setting, and Participants A retrospective cohort study of discharge records, which were examined to determine hospital and operator procedure volumes, of 97 401 patients undergoing PTCA in New York, New Jersey, and Florida in 2001. Travel distances were measured at baseline and under 2 regionalization scenarios in which hospital-operator pairs not meeting minimum volume standards stopped providing services.
Main Outcome Measures Observed and expected patient travel distances, and risk-adjusted mortality.
Results With a minimum volume standard of 175 per operator and 400 per hospital (class 1), 25% of patients had a shorter travel distance, 10% had a longer travel distance, and 65% experienced no change. Most patients with longer travel distances under this standard would travel no more than 25 miles farther, and most patients with shorter travel distances would save no more than 10 miles. With a minimum volume standard of 75 per operator and 400 per hospital (class 2), 11% of patients had a shorter travel distance, 2% had a longer travel distance, and 87% experienced no change. Under both standards, less than 1% of patients would travel more than 50 miles farther than their observed travel distance. Risk-adjusted mortality was higher for lower-volume hospital-operator pairs (1.2% for class 3 vs 0.9% for class 2 and 0.8% for class 1; P<.001 for both comparisons).
Conclusion Regionalization of PTCA would not increase travel distance for most patients; however, potential costs of regionalization not related to travel must be examined before such policies can be recommended.
Author Affiliations: Center for Clinical and Genetic Economics, Duke Clinical Research Institute, and Duke University School of Medicine, Duke University Medical Center (Drs Curtis and Schulman, and Ms Kansagra), and Health Sector Management Program, The Fuqua School of Business, Duke University (Dr Schulman and Ms Kansagra), Durham, NC.
Corresponding Author: Kevin A. Schulman, MD, Center for Clinical and Genetic Economics, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715 (kevin.schulman{at}duke.edu).
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