Lu Tsung-Hsueh, Huang Yu-Tung, Lee Jo-Chi, Yang Li-Tan, Liang Fu-Wen, Yin Wei-Hsian, Kawachi Ichiro
Department of Public Health, National Cheng Kung University, Tainan, Taiwan (T.H.L., J.C.L., F.W.L.).
Program in Ageing and Long-term Care, Kaohsiuang Medical University, Kaohsiung, Taiwan (Y.T.H.).
J Am Heart Assoc. 2015 Dec 23;4(12):e002840. doi: 10.1161/JAHA.115.002840.
Studies in the United States suggested that the characteristics of hospitals providing percutaneous coronary intervention (PCI) differed from those not providing PCI. However, little is known on the differences between the characteristics of early-adopting hospitals and those of late-adopting hospitals, and on their potential impacts on PCI volume and access.
We used inpatient claims data from 1997 to 2012 from the Taiwan National Health Insurance program to identify the hospitals offering PCI. Geographic information systems (GIS) were used to determine the population access to PCI hospital. As of 2012, 88 hospitals were capable of providing PCI. On the basis of the year that the hospitals started providing PCI, 32 hospitals were designated as early adopters (before 1998), 23 as early majority (1998-2002), 24 as late majority (2003-2007), and 16 as laggards (2008-2012). Hospitals that adopted PCI later were smaller in size and closer to an existing PCI hospital and had lower PCI volumes performed and less bypass surgery support. The median PCI volumes in 2012 were n=706, 330, 138, and 81 in early adopters, early majority, late majority, and laggards, respectively. Despite the low volume of PCI performed in laggard hospitals, the percentage with ST-elevation myocardial infarction and acute myocardial infarction as principal discharge diagnosis was higher than their early-adopting hospital counterparts. The percentage of the Taiwanese population living within 40 km of PCI hospitals (appropriate access defined in this study) was 95.7% in 1997 and 98.0% in 2002, and this has remained unchanged since 2002.
The characteristics of early-adopting hospitals differed from those of late-adopting hospitals. Despite lower PCI volume performed in late-adopting hospitals, many of them are in remote areas and provide needed and timely services for patients with acute myocardial infarction.
美国的研究表明，提供经皮冠状动脉介入治疗（PCI）的医院特征与不提供PCI的医院不同。然而，对于早期采用PCI的医院和晚期采用PCI的医院在特征上的差异，以及它们对PCI手术量和可及性的潜在影响，人们了解甚少。
我们使用了台湾全民健康保险计划1997年至2012年的住院理赔数据来确定提供PCI的医院。利用地理信息系统（GIS）来确定民众前往PCI医院的可及性。截至2012年，有88家医院能够提供PCI。根据医院开始提供PCI的年份，32家医院被指定为早期采用者（1998年之前），23家为早期多数采用者（1998 - 2002年），24家为晚期多数采用者（2003 - 2007年），16家为滞后采用者（2008 - 2012年）。较晚采用PCI的医院规模较小，距离现有的PCI医院更近，进行的PCI手术量较少，且搭桥手术支持也较少。2012年，早期采用者、早期多数采用者、晚期多数采用者和滞后采用者的PCI手术量中位数分别为n = 706、330、138和81。尽管滞后采用者医院的PCI手术量较低，但以ST段抬高型心肌梗死和急性心肌梗死作为主要出院诊断的比例高于早期采用者医院。1997年，居住在距离PCI医院40公里范围内（本研究定义的适宜可及性）的台湾人口比例为95.7%，2002年为98.0%，自2002年以来这一比例保持不变。
早期采用PCI的医院与晚期采用PCI的医院特征不同。尽管晚期采用者医院的PCI手术量较低，但其中许多位于偏远地区，为急性心肌梗死患者提供了必要且及时的服务。
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