New Cardiac Surgery Programs: Patients, Outcomes, Access

新的心脏手术项目：患者、结果、可及性

• 批准号: 7033540
• 负责人: Frances Lee Lucas
• 金额: $ 40.36万
• 依托单位: MAINEHEALTH
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-02-01 至 2008-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7033540
• 关键词: Medicare /Medicaid; behavioral /social science research tag; coronary bypass; health care model; health care personnel education; health care personnel performance; health care service evaluation; health care service utilization; health science manpower; health services research tag; heart revascularization; human data; human mortality; mathematical model; medical outreach /case finding; medical records; outcomes research; patient safety /medical error; physicians; training

DESCRIPTION (provided by applicant): Recent years have seen a dramatic increase in the number of hospitals providing coronary artery bypass surgery (CABG) services. This trend may provide improved access for patients but such access might be provided at a price. It is well known that high volume programs and high volume surgeons have, on average, better outcomes than programs and surgeons that perform fewer procedures. In addition, there is likely to be a 'learning curve' involved in any start-up program. There is little literature that directly addresses the question of the impact of a new cardiac surgery program on patients and their outcomes or oh the population at large. Medicare data are comprehensive, national in scope, provide information about operating institutions and physicians, and allow assessment of outcomes over time. We wish to use Medicare data to identify new cardiac programs over a ten year period, 1994-2003, and answer the following questions: 1) How do new cardiac programs address the 'learning curve' question? Do they select low risk patients, perform low risk procedures, recruit experienced surgeons? 2) How long does it take for new programs to move beyond the 'learning curve'? How quickly do new programs achieve acceptable minimum volume? Are outcomes different in new programs? How quickly do the outcomes in new programs approach those in established programs? 3) What happens to utilization of CABG in the population when a new program is initiated? Are new programs opened in markets where no other program exists? Does the addition of a new program to a local health care system result in a redistribution of existing procedures or result in an overall increase in the population-based rates of care, including CABG and total revascularization (either CABG or percutaneous coronary interventions) as additional capacity is brought online?

描述（由申请人提供）：近年来，提供​​冠状动脉搭桥手术（CABG）服务的医院数量急剧增加。这种趋势可能可以改善患者的访问权限，但可以以价格提供此类访问。众所周知，与执行较少手术的计划和外科医生相比，大量计划和大量外科医生的结果平均更好。此外，任何启动计划都可能涉及“学习曲线”。几乎没有文献直接解决了新的心脏手术计划对患者及其结果的影响或整个人口的影响。 Medicare数据是全面的，国家的范围是全国性的，提供有关运营机构和医师的信息，并允许随着时间的推移评估结果。我们希望使用Medicare数据在1994 - 2003年的十年期间确定新的心脏计划，并回答以下问题：1）新的心脏计划如何解决“学习曲线”问题？他们是否选择低风险患者，执行低风险程序，招募经验丰富的外科医生？ 2）新程序超越“学习曲线”需要多长时间？新程序的最低量如何迅速？新计划的结果有所不同吗？新计划中的结果如何快速接触已建立计划中的结果？ 3）当启动新计划时，在人群中使用CABG会发生什么？在没有其他计划的市场中开放了新计划吗？在当地医疗保健系统中增加新计划是否会导致现有程序的重新分配，或者导致基于人群的护理率的总体上升，包括CABG和总血运重建（CABG或经皮冠状动脉干预措施），因为额外的能力是在线上的？