Abstract 15545: Geographic Regions With Low PCI Utilization Perform More Appropriate Percutaneous Coronary Interventions
Background: There is substantial geographic variation in PCI rates across the United States. It is unclear the extent to which these differences in PCI rates correlate with varying categories of appropriate use criteria (AUC) for the procedure.
Objectives: To study the relationship between PCI rates across regional healthcare markets utilizing hospital referral regions (HRRs) and the appropriateness of PCI within that HRR.
Methods: The number of PCI procedures in each zip code was obtained from the 100% Medicare limited data set from 2010. These data were then aggregated to the HRR level using zip crosswalk files from the Dartmouth Atlas of Health Care to map zip code to HRR. Using Medicare data, these HRRs were then divided into quintiles of PCI utilization with increasing rates of utilization progressing from quintile 1 to 5. To assess AUC, we focused on HRRs in which greater than 80% of the total number of PCIs were performed at hospitals participating in the CathPCI Registry®. The registry data were then used to evaluate patient characteristics, AUC, and outcomes across the quintiles defined by PCI utilization. Appropriateness of PCI was defined using the 2009 ACC/AHA/SCAI AUC.
Results: In 2010, valid zip code that could be mapped to an HRR that had 80% penetrance in CathPCI Registry were available for 380,981 patients. The proportion of patients who underwent PCI for acute coronary syndrome was 72.3% in quintile 1, 70.61% in Q 2, 71.48% in Q 3, 69.3% in Q 4, and 69.34% in Q 5. The proportion of appropriate PCI varied significantly across HRRs (Figure). The rates for appropriate, inappropriate, uncertain, and not mappable for all PCIs in each quintile are: Q1 76.53%, 3.92%, 8.29%, and 11.26%, respectively; Q2 75.26%, 4.23%, 8.84%, and 11.67%; Q3 75.23%, 4.32%, 8.08%, and 12.37%; Q4 73.95%, 4.35%, 9.01%, and 12.69%; and Q5 72.68%, 4.05%, 8.93%, and 14.34%; p<.0001.
Conclusions: Geographic regions with lower PCI rates are more likely to perform PCI for appropriate indications per AUC.
- © 2013 by American Heart Association, Inc.