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ESTIMATING THE VOLUME-OUTCOME RELATIONSHIP OF PERCUTANEOUS CORONARY INTERVENTION (PCI) - A CALIFORNIA RETROSPECTIVE COHORT STUDY
Other Title
ESTIMATING THE VOLUME-OUTCOME RELATIONSHIP OF PERCUTANEOUS CORONARY INTERVENTION (PCI) - A CALIFORNIA RETROSPECTIVE COHORT STUDY
Type
thesis
Date Issued
2022-06-02
Author(s)
NGUYEN VY KHANH
Advisor
郭乃文
Subjects
系所名稱：醫務管理學系碩士班
Publisher
醫務管理學系碩士班
Description
口試委員：郭乃文 KUO, NAI-WEN;石崇良 SHIH, CHUNG-LIANG;林恆慶 LIN, HERNG-CHING
網際網路,開放日期為2022-07-27
網際網路,開放日期為2022-07-27
Abstract
Title: Estimating the Volume-Outcome Relationship of Percutaneous Coronary Intervention (PCI) – A California Retrospective Cohort Study.
Author: Nguyen Vy Khanh
Thesis advised by: Professor Nai-Wen Kuo, Ph.D., M.P.H
Background: Hospital procedural volume has been considered one the key indicators used when evaluating the facility’s quality of care, where significant growth in previous studies succeeded in proving higher hospital volumes (procedural and/or postsurgical) resulted in better outcomes (lower mortality rate, readmission rate or length of stay depending on the nature of the study’s conducted). This study aimed to estimate the volume-outcome relationship of percutaneous coronary intervention (PCI) in California hospitals and examining the impacts of other available hospital characteristics on this relationship from January 1, 2016 to December 31, 2018.
Methods: This retrospective cohort study combined and utilizing different datasets retrieved from the California’s Office of State-wide Health Planning and Development. Key hospital characteristics selected including hospital teaching status, types of ownership, CMI, licensed bed counts and hospital locations. Statistical Package for the Social Sciences (SPSS) version 19.0 and Microsoft Excel 2020 were employed for the statistical analyses of three years data, total 479 hospitals. Statistical significance was set at p<0.05.
Results: The study regression analyses has indicated hospitals classified as low-volume were associated with higher risk-adjusted mortality rate (RAMR) (p<0.0001). Other model predictors (intermediate and high-volume categories) as well as confounding variables (hospital characteristics) posed inconclusive correlation to the outcome.
Conclusions: Inverse relationship of between hospital procedural volume and corresponding outcomes could be partially proven when classifying the procedural volume of interest into low, intermediate, and high-volume. Due to a more factor-driven nature, more instruments and better approaches would be needed when investigating the volume-outcome relationship of intermediate and high-volume hospitals, such as length of stay or readmission rate.
Keywords: percutaneous coronary intervention, practice-make-perfect, volume-outcome relationship, case-mix index, hospital ownerships, quality of care, hospital teaching status.
Author: Nguyen Vy Khanh
Thesis advised by: Professor Nai-Wen Kuo, Ph.D., M.P.H
Background: Hospital procedural volume has been considered one the key indicators used when evaluating the facility’s quality of care, where significant growth in previous studies succeeded in proving higher hospital volumes (procedural and/or postsurgical) resulted in better outcomes (lower mortality rate, readmission rate or length of stay depending on the nature of the study’s conducted). This study aimed to estimate the volume-outcome relationship of percutaneous coronary intervention (PCI) in California hospitals and examining the impacts of other available hospital characteristics on this relationship from January 1, 2016 to December 31, 2018.
Methods: This retrospective cohort study combined and utilizing different datasets retrieved from the California’s Office of State-wide Health Planning and Development. Key hospital characteristics selected including hospital teaching status, types of ownership, CMI, licensed bed counts and hospital locations. Statistical Package for the Social Sciences (SPSS) version 19.0 and Microsoft Excel 2020 were employed for the statistical analyses of three years data, total 479 hospitals. Statistical significance was set at p<0.05.
Results: The study regression analyses has indicated hospitals classified as low-volume were associated with higher risk-adjusted mortality rate (RAMR) (p<0.0001). Other model predictors (intermediate and high-volume categories) as well as confounding variables (hospital characteristics) posed inconclusive correlation to the outcome.
Conclusions: Inverse relationship of between hospital procedural volume and corresponding outcomes could be partially proven when classifying the procedural volume of interest into low, intermediate, and high-volume. Due to a more factor-driven nature, more instruments and better approaches would be needed when investigating the volume-outcome relationship of intermediate and high-volume hospitals, such as length of stay or readmission rate.
Keywords: percutaneous coronary intervention, practice-make-perfect, volume-outcome relationship, case-mix index, hospital ownerships, quality of care, hospital teaching status.