The implementation of centralization for high-risk surgery -estimating potentially avoidable outcomes of cardiac procedures

Abstract

Objectives: The aim of this study was to estimate how many adverse outcomes could potentially be avoided in Taiwan if a centralization policy were implemented for Percutaneous Transluminal Coronary Angioplasty (PTCA) and/or Coronary Artery Bypass Grafting (CABG). We further examined how such a policy might affect accessibility to care as well as the potential for financial losses in low-volume hospitals. Methods: The study population included 9530 patients who underwent PTCA or CABG for the first time between 2010 and 2012. We used multilevel logistic regression and G-computation to estimate the number of potentially avoidable adverse outcomes, and we predicted how many patients would have to travel farther to access medical care as a result of a centralization policy. Finally, we predicted the impact that centralization of surgery would have on inpatient revenue in low-volume hospitals by calculating the ratio of revenue from inpatient cardiac procedures to total hospital inpatient revenue. Results: We found that 4,150 of the 9,530 patients who underwent CABG were admitted to low-volume hospitals. We estimated that centralization of PTCA and CABG could reduce the number of deaths by 442 and 127, respectively, and 12% of the patients who underwent PTCA and 18% of patients who underwent CABG would have to travel farther to access medical care. We determined that low-volume hospitals incurred financial losses of approximately 6% and 2%, respectively, by referring PTCA and CABG patients to higher-volume surgical centers. Conclusions: Centralization policies could have a positive impact on healthcare outcomes, only a minor impact on accessibility to care for patients, and minor financial consequences for low-volume hospitals. (Taiwan J Public Health. 2016;35(6):611-630).