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To the Editor: Ms Kansagra and colleagues¹ concluded that regionalization policies for percutaneous transluminal coronary angioplasty would not affect patient travel distances. Although the study and results are compelling, additional analyses may provide further insight and possibly different findings. Results from New Jersey, New York, and Florida may not be applicable to other states with lower physician and population densities. Also, the overall results may not reflect variation among different regions (eg, Western New York, Florida panhandle) and counties within the 3 states.Regionalization could have significantly different effects on rural, suburban, and urban areas that have varying access to physicians and hospitals. For example, Losina et al² found that policies restricting total hip replacements to high-volume centers would differentially affect poor, less-educated, and rural patients. Stratifying the analysis by population density, socioeconomic indicators, types of insurance carriers, and health care professional and facility density may be very valuable.

The authors . . . [Full Text of this Article]

Bruce Y. Lee, MD, MBA
brucelee@mail.med.upenn.edu
Division of General Internal Medicine

Anand Shah, BS
School of Medicine

Esther H. Chen, MD
Department of Emergency Medicine
University of Pennsylvania
Philadelphia

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