Abstract 18805: Association of State Certificate of Need Regulations With the Appropriateness of PCI Procedures

Abstract

Introduction: Certificate of Need (CON) regulations are intended to limit healthcare infrastructure to control healthcare costs, prevent overuse, and improve quality of care. However, there is limited information about the impact of CON regulations on the use of invasive cardiac procedures. To address this gap, we examined the association of state CON regulations with the appropriateness of percutaneous coronary interventions (PCI). Methods: We used data from the ACC’s CathPCI Registry to analyze 1,143,402 PCIs performed at 1,297 hospitals between January 2010 and December 2011. We applied the 2012 Appropriate Use Criteria (AUC) to determine whether the procedure was considered appropriate, uncertain, or inappropriate, and we used chi-square analyses to assess whether the proportions of PCIs AUC categories differed depending on whether the procedure had been performed in a state with or without CON regulations. Analyses were repeated stratified by whether or not the procedure was performed in the setting of an acute coronary syndrome (ACS). Results: The characteristics and outcomes of patients undergoing PCI were similar in states with and without CON. The proportion of PCIs considered appropriate in non-CON states was slightly lower compared with CON states (85.5% versus 86.2%), and a higher proportion of procedures were considered inappropriate (4.6% versus 4.2%) [Table]. Absolute differences were larger among non-ACS PCI patients and were not statistically significant among ACS PCI patients. Conclusions: States with CON had a lower proportion of inappropriate PCIs as compared with states without CON. However, the absolute differences were small, suggesting that CON regulations alone may have a limited impact on preventing potential overuse of PCI procedures.