Iowa City Veterans Affairs Medical Center, IA University of Iowa, Iowa City, IA 52246, USA.
Med Care Res Rev. 2010 Apr;67(2):213-31. doi: 10.1177/1077558709346565. Epub 2009 Oct 12.
This study examines trends in the diffusion of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) during 1993-2004 for patients with acute myocardial infarction in markets with and without Certificate of Need (CON) regulations for open-heart surgery or cardiac catheterization and in markets that repealed CON for either of these procedures. In contrast to prior studies, this study accounts for regional hospital markets that cross state boundaries-often with different CON activities in each state. The overall use of CABG increased modestly throughout the 1990s and subsequently decreased, corresponding to a dramatic increase in PCI. There was a greater rise in the number of CABG programs in markets with significant reduction in CON regulations during 1993-2004 compared with other markets, but CON reduction was not related to growth of PCI programs. Reimbursement, ease of use, clinician endorsement, and technological advances in PCI may outweigh effects of CON.
本研究考察了 1993-2004 年间在有无心脏手术和心脏导管插入术需求批准（CON）规定的市场以及废除 CON 这两种程序的市场中，急性心肌梗死患者进行冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）的扩散趋势。与之前的研究相比，本研究考虑了跨越州界的区域医院市场，这些市场通常在每个州都有不同的 CON 活动。20 世纪 90 年代，CABG 的整体使用量略有增加，随后减少，与 PCI 的大幅增加相对应。在 1993-2004 年期间，CON 规定大幅减少的市场中 CABG 项目数量增加较多，而其他市场则有所减少，但 CON 减少与 PCI 项目的增长无关。PCI 的报销、易用性、临床医生的认可和技术进步可能超过 CON 的影响。
