Abstract 113: Regional Variation In The Receipt Of Coronary Revascularization Following Diagnostic Catheterization In British Columbia
Notice bibliographique
Résumé
Background: Differences in the management of coronary artery disease have previously been found to be partly attributable to non-clinical factors, but there have been few studies examining this issue in Canada. Variation in revascularization rates across regions of the province of British Columbia (BC) has been previously observed but not studied. The BC Cardiac Registry allows a unique opportunity to explore the factors that contribute to this variation and the associated clinical outcomes. Methods: All BC residents aged 20 years and older who received a diagnostic catheterization between 2008/09 and 2010/11 in one of five hospitals in the province with a catheterization laboratory were identified from the BC Cardiac Registry, a longitudinal clinical registry of all cardiac procedures performed in the province. Patients were followed to determine hospital level rates of revascularization (PCI or CABG) within 90 days of the diagnostic catheterization. Risk-adjustment was performed with a logistic regression model to determine whether the cathing hospital was an independent predictor of revascularization rates. All cause mortality rates following diagnostic catheterization were calculated and Cox regression was used to determine the effect of the cathing hospital on 1-year mortality. Results: The cohort included 32,585 diagnostic catheterization cases, of which 73.9% (24,076) received revascularization within 90 days. Unadjusted hospital rates ranged from 64.6% (2,730 of 4,224) to 83.8% (5,135 of 6,130). Among cases who received revascularization, the PCI:CABG ratios ranged from 3.1 to 4.7. The logistic regression model measuring the association between cathing hospital and the receipt of revascularization demonstrated significant hospital differences, despite controlling for demographic and clinical risk factors. The OR of receiving revascularization at hospital B compared to hospital A was nearly 3-fold (OR=2.8, 95% CI 2.6 - 3.1). There were also significant hospital differences after risk-adjustment in the receipt of PCI vs. CABG. Hospital C was more likely to treat patients with PCI (OR=1.3, 95% CI 1.2-1.5) compared to hospital A. Exploration of interaction terms found that hospital differences were significant among STEMI patients. The probability of mortality at 1 year following diagnostic catheterization ranged from 0.035 to 0.067 among hospitals, based on Kaplan-Meier estimation. Cox regression modeling revealed that there were significant hospital differences in 1-year mortality after adjusting for patient characteristics. Conclusions: There was substantial regional variation in revascularization practice among hospitals in the province of British Columbia, Canada. Identification of subgroups where variation in practices were significant, such as use of PCI vs. CABG among STEMI patients, offer opportunities for follow-up and quality improvement.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».