Contemporary impact of state certificate-of-need regulations for cardiac surgery - An analysis using the Society of Thoracic Surgeons' National Cardiac Surgery Database

被引:29
作者
DiSesa, Verdi J.
O'Brien, Sean M.
Welke, Karl F.
Beland, Sarah M.
Haan, Constance K.
Vaughan-Sarrazin, Mary S.
Peterson, Eric D.
机构
[1] Chester Cty Hosp, W Chester, PA 19301 USA
[2] Duke Univ, Clin Res Inst, Durham, NC USA
[3] Oregon Hlth & Sci Univ, Portland, OR 97201 USA
[4] Univ Florida, Jacksonville, FL USA
[5] Univ Iowa, Iowa City, IA USA
关键词
coronary disease; morbidity; mortality; surgery;
D O I
10.1161/CIRCULATIONAHA.105.591214
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background - Prior research using administrative data associated certificate-of-need (CON) regulation for open heart surgery with higher hospital coronary artery bypass grafting (CABG) volume and lower CABG operative mortality rates in elderly patients. It is unclear whether these findings apply in a general population and after controlling for detailed clinical characteristics and region. Methods and Results - Using the Society of Thoracic Surgeons' (STS) National Cardiac Surgery Database, we examined isolated CABG surgery volume, operative mortality, and the composite end point of operative mortality or major morbidity for the years 2000 to 2003. The presence of CON regulations for open heart surgery was ascertained from the National Directory of the American Health Policy Association and by contacting CON administrators. Results were analyzed nationally, by state, and by region (West, Northeast, Midwest, South) and were adjusted for clinical factors and both population density and region with mixed-effects hierarchical logistic regression models. During 2000 to 2003, there were 314 710 isolated CABG surgeries performed at 294 STS hospitals in CON states (n = 27, including Washington, DC) and 280 512 procedures at 343 STS hospitals in non-CON states (n = 24). Patient clinical characteristics were similar among CON and non-CON hospitals. States with CON regulations tended to have higher population densities and had significantly higher median hospital annual CABG volumes in each of the years 2000 to 2003 (P < 0.005). This difference remained significant after adjustment for region and population density. Operative mortality was 2.52% for CON versus 2.62% for non-CON states (P = 0.32). There was a significant association between CON law and operative mortality in the South. After adjustment for patient risk factors and region, there was a marginally significant reduction of mortality risk in states with CON regulation (adjusted OR 0.92, 95% CI 0.86 to 1.00). However, this difference was not statistically significant when a revised model accounted for random state effects. Similar volume and outcomes results were seen when the analysis was repeated with data from the national Medicare database. Conclusions - CON states have significantly higher hospital CABG surgery volumes but similar mortality compared with non-CON states. CON regulation alone is not a sufficient mechanism to ensure quality of care for CABG surgery.
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收藏
页码:2122 / 2129
页数:8
相关论文
共 30 条
[1]  
*AM HLTH PLANN ASS, 2004, NAT DIR HLTH PLANN P
[2]   Surgeon volume and operative mortality in the United States [J].
Birkmeyer, JD ;
Stukel, TA ;
Siewers, AE ;
Goodney, PP ;
Wennberg, DE ;
Lucas, FL .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 349 (22) :2117-2127
[3]   Surgeon specific mortality in. adult cardiac surgery: comparison between crude and risk stratified data [J].
Bridgewater, B ;
Grayson, AD ;
Jackson, M ;
Brooks, N ;
Grotte, GJ ;
Keenan, DJM ;
Millner, R ;
Fabri, BM ;
Jones, M .
BMJ-BRITISH MEDICAL JOURNAL, 2003, 327 (7405) :13-17
[4]  
Carey JS, 2003, AM SURGEON, V69, P63
[5]  
CONOVER CJ, 1998, J HLTH POLITICS POLI, V35, P280
[6]   Volume requirements for cardiac surgery credentialing: A critical examination [J].
Crawford, FA ;
Anderson, RP ;
Clark, RE ;
Grover, FL ;
Kouchoukos, NT ;
Waldhausen, JA ;
Wilcox, BR .
ANNALS OF THORACIC SURGERY, 1996, 61 (01) :12-16
[7]   Surgeon specialty and provider volumes are related to outcome of intact abdominal aortic aneurysm repair in the United States [J].
Dimick, JB ;
Cowan, JA ;
Stanley, JC ;
Henke, PK ;
Pronovost, PJ ;
Upchurch, GR .
JOURNAL OF VASCULAR SURGERY, 2003, 38 (04) :739-744
[8]   Use of continuous quality improvement to increase use of process measures in patients undergoing coronary artery bypass graft surgery - A randomized controlled trial [J].
Ferguson, TB ;
Peterson, ED ;
Coombs, LP ;
Eiken, MC ;
Carey, ML ;
Grover, FL ;
DeLong, ER .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2003, 290 (01) :49-56
[9]   A decade of change - Risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990-1999: A report from the STS National Database Committee and the Duke Clinical Research Institute [J].
Ferguson, TB ;
Hammill, BG ;
Peterson, ED ;
DeLong, ER ;
Grover, FL .
ANNALS OF THORACIC SURGERY, 2002, 73 (02) :480-489
[10]   Comparing outcomes of coronary artery bypass surgery: Is the New York Cardiac Surgery Reporting System model sensitive to changes in case mix? [J].
Glance, LG ;
Osler, TM .
CRITICAL CARE MEDICINE, 2001, 29 (11) :2090-2096