Date of Award

January 2014

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Joseph S. Ross

Subject Area(s)

Medicine

Abstract

It is not known whether hospitals with percutaneous coronary intervention (PCI) capability provide more costly care than hospitals without PCI capability for patients admitted for acute myocardial infarction (AMI). The growing number of PCI-capable hospitals and higher rate of PCI use at technologically advanced hospitals may result in higher costs for episodes of care initiated at PCI hospitals. However, higher rates of transfers and post-acute care procedures may result in higher costs for episodes of care initiated at non-PCI hospitals.

We identified all AMI admissions in 2008 among Medicare fee-for-service beneficiaries and classified hospitals as PCI- or non-PCI-capable based on hospitals' 2007 PCI performance. We added all payments from the time of admission through 30 days post-admission, including payments to hospitals other than the admitting hospital. We calculated and compared risk- standardized payment for PCI and non-PCI hospitals using 2-level hierarchical generalized linear models that adjust for patient demographics and clinical characteristics. PCI hospitals had a slightly higher mean 30-day risk-standardized payment than non-PCI hospitals ($20,340 v. $19,713, P<0.001). Patients presenting to PCI hospitals had higher PCI rates (39.2% v. 13.2%, P<0.001) and higher coronary artery bypass graft (CABG) rates (9.5% v. 4.4%, P<0.001) during index AMI admissions, lower transfer rates (2.2% v. 25.4%, P<0.001), and lower revascularization rates within 30 days (0.15% v. 0.27%, P<0.0001) than those presenting to non- PCI hospitals.

Despite higher PCI and CABG rates for patients who began their 30-day episode of care at PCI hospitals, PCI hospitals were only $627 more costly than non-PCI hospitals for the treatment of patients with AMI.

Comments

This is an Open Access Thesis.

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