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Previous Volume 352:1454-1462 April 7, 2005 Number 14 Next

	Full Text PDF PDA Full Text Supplementary Material Perspective by Iglehart, J. K. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background The emergence of specialty hospitals focusing on narrow procedural areas has generated controversy, although little is known about their quality.

Methods We conducted a retrospective cohort study of 42,737 Medicare beneficiaries who underwent percutaneous coronary intervention (PCI) and 26,274 who underwent coronary-artery bypass grafting (CABG) during 2000 and 2001 in specialty cardiac hospitals (15 for PCI and 15 for CABG) and general hospitals (82 for PCI and 75 for CABG) in the same markets. Administrative data were used to compare patients' characteristics, hospital procedural volumes, and patient outcomes.

Results Patients undergoing PCI or CABG in specialty hospitals were less likely to have coexisting conditions than those being treated at general hospitals and were less likely to have had an acute myocardial infarction (P<0.001). The better health of the patients at specialty hospitals than of those at general hospitals was reflected by the lower mean predicted risk of death (2.1 percent vs. 3.1 percent for PCI and 5.0 percent vs. 5.8 percent for CABG; P<0.001 for each comparison). Mean volumes of PCI and CABG procedures in 2000 and 2001 were higher in specialty hospitals than in general hospitals (799 vs. 375 PCI procedures, P<0.001; and 571 vs. 236 CABG procedures, P<0.001). The unadjusted rate of death during the index hospitalization or within 30 days after admission was lower in specialty hospitals than in general hospitals (2.1 percent vs. 3.2 percent for PCI and 4.7 percent vs. 6.0 percent for CABG; P<0.001 for both comparisons). In multivariate analyses adjusted for patients' characteristics, the odds ratio for death after PCI in specialty hospitals and general hospitals was similar (0.89; 95 percent confidence interval, 0.69 to 1.15; P=0.39), but the odds ratio for death after CABG was lower in specialty hospitals than in general hospitals (0.84; 95 percent confidence interval, 0.72 to 0.99; P=0.05). In stratified analyses comparing specialty and general hospitals with similar volumes, differences in mortality were not significant.

Conclusions The lower unadjusted mortality rate after cardiac revascularization in specialty cardiac hospitals is accounted for by their healthier patients and higher procedural volumes.

Source Information

From the Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine (P.C., G.E.R., M.V.-S.), and the Center for Research in the Implementation of Innovative Strategies for Practice, Iowa City Veterans Affairs Medical Center (G.E.R., M.V.-S.) — both in Iowa City.

Address reprint requests to Dr. Cram at the Department of Medicine, University of Iowa College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, or at peter-cram{at}uiowa.edu.

Full Text of this Article

Related Letters:

Cardiac Revascularization in Specialty and General Hospitals
Young J. K., Foster D. A., Heller S. T., Ballard D. J., Edwards F. H., Welke K. F., Levitsky S., Cram P., Rosenthal G. E., Vaughan-Sarrazin M. S.
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N Engl J Med 2005; 352:2754-2756, Jun 30, 2005. Correspondence

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