There is a well-established association between hospitals performing higher volumes of percutaneous coronary intervention (PCI) and improved patient outcomes. However, a new study reveals that the probability of receiving PCI in a low-volume hospital has increased over time, and not just for historically underserved populations. This increase persists across Black, Latinx, white, and Asian patients, as well as patients with Medicare, Medicaid, private insurance, or no insurance, and across all income levels.
In a study published Jan. 18, 2023, in PLOS ONE, researchers from UC San Francisco and the Yale School of Medicine, conducted a retrospective cohort study utilizing data from 374,066 patients hospitalized in California, who received PCI from 2010-2018. The team studied the trends across numerous patient demographics including race, insurance and income to uncover differences in the likelihood of receiving PCI at low-volume hospitals and in low versus high-income communities.
The researchers reported that Black, Latinx, and Asian patients were more likely to receive PCI at low-volume hospitals compared with non-Latinx white patients. Medicaid beneficiaries were also more likely to end up at low-volume PCI hospitals respective to other insurance groups. Interestingly, high-income patients were as well, though these visits appeared to be most represented in low-volume PCI centers in high-income neighborhoods.
PCI capacity in the U.S. has increased over recent decades, despite a lower prevalence of coronary artery disease and a decreasing absolute number of inpatient PCI procedures, potentially contributing to the observed, lower per-hospital PCI volumes.
“These results show that all patients receiving cardiac intervention, regardless of income and sociodemographic characteristics, are more likely to receive their care at a low-volume hospital today compared to a decade ago,” said Renee Hsia, MD, senior author and UCSF professor of emergency medicine. “Our findings beg the question of whether the current incentives of how we provide health care services as a society is in the best interest of patients and whether we need to re-evaluate the status quo.”
When looking specifically at these likelihoods in low-income communities, the probability of PCI at a low-volume hospital was higher for low-income patients than for high-income and the observed differences across racial groups were more pronounced.
“Our study’s findings make a case for ongoing policy research regarding equitable creation of new PCI-capable facilities as to not worsen existing disparities,” said study first author Christina Wang, MD, a resident physician at UCSF.
Authors: Christina Wang, MD, Department of Internal Medicine, UCSF; Karla Lindquist, PhD, Department of Epidemiology and Biostatistics, UCSF; Harlan Krumholz, MD, SM, Department of Cardiology, Yale School of Medicine; and Renee Y. Hsia, MD, MSc, Department of Emergency Medicine, UCSF and Philip R. Lee Institute for Health Policy Studies, UCSF.
Funding: The study was supported by the National Heart, Lung, and Blood Institute through the NIH (R01HL114822 and R01HL134182).
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