TY - JOUR
T1 - Economic and clinical impact of routine weekend catheterization services
AU - Long, Kirsten Hall
AU - Moriarty, James P.
AU - Ransom, Jeanine E.
AU - Lennon, Ryan J.
AU - Mathew, Verghese
AU - Gulati, Rajiv
AU - Sandhu, Gurpreet S.
AU - Rihal, Charanjit S.
N1 - Funding Information:
The authors thank Ron Menaker for administrative operational support as well as Steven Winter and Susan Eastman Hegge for assistance with the clinical scheduling tool, iVIEW, used to identify catheterization events of interest and associated patient characteristics. Funded by the Mayo Foundation for Medical Education and Research and from resources supported by the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health (grant R01 AG034676).
Publisher Copyright:
© 2016, Ascend Media. All rights reserved.
PY - 2016/7
Y1 - 2016/7
N2 - Objectives: To assess the impact of weekend cardiac catheterization (cath) services for nonemergent inpatients. Study Design: Retrospective cohort study of patients undergoing cath before and after Saturday cath service availability (CSA). Methods: Cohorts included Friday and Saturday admissions with cath (with or without revascularization) on the subsequent Monday from January 1, 2007, to December 31, 2008 (pre-CSA events), and Friday or Saturday admissions undergoing cath the subsequent or same Saturday from January 1, 2009, to December 31, 2010 (post-CSA events). Administrative and registry data provided demographics, comorbidities, percutaneous coronary intervention (PCI) details, adverse events, hospital length of stay (LOS), and inpatient expenditures. We used generalized linear modeling to predict LOS and costs, and logistic regression to estimate the likelihood of adverse events during follow-up. Results: We identified 331 pre-CSA cases (327 patients) and 244 post-CSA cases (243 patients). Cohorts were similar in age (66 years), sex (59% male), and level of comorbidity. PCI use was higher following CSA (42% vs 26%; P <.001), with procedural success accomplished in 95% and 94% of pre- and post-CSA patients, respectively. Adjusted clinical outcomes were similar (odds ratio [OR] for in-hospital mortality, 0.67 post-CSA vs pre-CSA; P = .55; OR for 30-day revascularization, 1.14; P = .68). Models predict an average LOS reduction of 1.7 days following CSA (5.7 vs 4.0 days; P <.001) yet inpatient costs were similar ($24,817 vs $24,753; 95% CI of difference, -$3611 to $3576). Conclusions: Weekend CSA for routine inpatients was clinically safe and effective, and reduced hospital LOS. Similar inpatient costs likely reflect a shift in case mix in this nonrandomized study.
AB - Objectives: To assess the impact of weekend cardiac catheterization (cath) services for nonemergent inpatients. Study Design: Retrospective cohort study of patients undergoing cath before and after Saturday cath service availability (CSA). Methods: Cohorts included Friday and Saturday admissions with cath (with or without revascularization) on the subsequent Monday from January 1, 2007, to December 31, 2008 (pre-CSA events), and Friday or Saturday admissions undergoing cath the subsequent or same Saturday from January 1, 2009, to December 31, 2010 (post-CSA events). Administrative and registry data provided demographics, comorbidities, percutaneous coronary intervention (PCI) details, adverse events, hospital length of stay (LOS), and inpatient expenditures. We used generalized linear modeling to predict LOS and costs, and logistic regression to estimate the likelihood of adverse events during follow-up. Results: We identified 331 pre-CSA cases (327 patients) and 244 post-CSA cases (243 patients). Cohorts were similar in age (66 years), sex (59% male), and level of comorbidity. PCI use was higher following CSA (42% vs 26%; P <.001), with procedural success accomplished in 95% and 94% of pre- and post-CSA patients, respectively. Adjusted clinical outcomes were similar (odds ratio [OR] for in-hospital mortality, 0.67 post-CSA vs pre-CSA; P = .55; OR for 30-day revascularization, 1.14; P = .68). Models predict an average LOS reduction of 1.7 days following CSA (5.7 vs 4.0 days; P <.001) yet inpatient costs were similar ($24,817 vs $24,753; 95% CI of difference, -$3611 to $3576). Conclusions: Weekend CSA for routine inpatients was clinically safe and effective, and reduced hospital LOS. Similar inpatient costs likely reflect a shift in case mix in this nonrandomized study.
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M3 - Article
C2 - 27442306
AN - SCOPUS:84978842940
SN - 1088-0224
VL - 22
SP - e233-e240
JO - American Journal of Managed Care
JF - American Journal of Managed Care
IS - 7
ER -