Advertisement
ADVANCED SEARCH

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: cmaj.060385v1 176/2/185    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Grilli, R. Articles by Taroni, F. Search for Related Content PubMed PubMed Citation Articles by Grilli, R. Articles by Taroni, F. Related Collections Other cardiovascular medicine Related Articles

Effect of hospital ownership status and payment structure on the adoption and use of drug-eluting stents for percutaneous coronary interventions

From the Agenzia Sanitaria Regionale (Grilli, Guastaroba), Regione Emilia Romagna, and the University of Bologna (Taroni), Bologna, Italy.

Correspondence to: Dr. Roberto Grilli, Agenzia Sanitaria Regionale, Viale Aldo Moro, 21, 40127 Bologna, Italy; fax +39-051-6397049; rgrilli{at}regione.emilia-romagna.it

Background: The impact of the use of drug-eluting stents in percutaneous coronary intervention (PCI) on cardiac care is still uncertain. We examined the influence of systemic factors, such as hospital ownership status, organizational characteristics and payment structure, on the use of drug-eluting stents in PCI and the effect on cardiac surgery volume.

Methods: We conducted a cross-sectional analysis of drug-eluting stent use in 12 993 patients undergoing PCI with stenting (drug-eluting or bare-metal) and time-series regression analyses of the monthly number of cardiac surgery and PCI procedures performed using data collected from 1998 to 2004 at 13 public and private hospitals in the Emilia-Romagna region of Italy.

Results: Public hospitals used drug-eluting stents more selectively than private hospitals, targeting the new device to patients at high risk of adverse events. The time-series regression analyses showed that the number of PCI procedures performed per year increased during this period, both in public (slope coefficient 36.4, 95% confidence interval [CI] 30.2 to 43.1) and private centres (slope coefficient 6.4, 95% CI 3.1 to 9.2 ). Concurrently, there was a reduction in the number of isolated coronary artery bypass graft (CABG) surgeries, although the degree of change was higher in public than in private hospitals (coefficient –16.1 v. –6.2 respectively ). The number of CABG procedures associated with valve surgery decreased in public hospitals (coefficient –5.0, 95% CI –6.1 to –3.8) but increased in private hospitals (coefficient 4.1, 95% CI 2.0 to 6.1).

Interpretation: Public and private hospitals behaved differently in adopting drug-eluting stents and in using PCI with drug-eluting stents as a substitute for surgical revascularization.

This article has been cited by other articles:

				D. Austin, K. G. Oldroyd, A. McConnachie, R. Slack, H. Eteiba, A. D. Flapan, K. P. Jennings, R. J. Northcote, A. C. H. Pell, I. R. Starkey, et al. Hospital and operator variations in drug-eluting stent use: a multi-level analysis of 5967 consecutive patients in Scotland J. Public Health Med., June 1, 2008; 30(2): 186 - 193. [Abstract] [Full Text] [PDF]

				M. H Wilson What fuels public policy? BMJ, March 24, 2007; 334(7594): 599 - 600. [Full Text] [PDF]

				M. L. Knudtson Drug-eluting coronary stents: faith and hope, but no charity Can. Med. Assoc. J., January 16, 2007; 176(2): 195 - 196. [Full Text] [PDF]

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-2007, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.