Abstract

BackgroundVariation in health care delivery among regions and hospitals has been observed worldwide and reported to have resulted in health inequalities. Regional variation of percutaneous coronary intervention (PCI) was previously reported in Japan. This study aimed to assess the small-area and hospital-level variations and to examine the influence of patient and hospital characteristics on the use of PCI.MethodsData provided by the Fukuoka Prefecture Latter-stage Elderly Insurance Association was used. There were 11,821 patients aged ≥65 years with acute coronary syndromes who were identified from 2015 to 2017. Three-level multilevel logistic regression analyses were performed to quantify the small-area and hospital variations, as well as, to identify the determinants of PCI use.ResultsThe results showed significant variation (δ2 = 0.744) and increased PCI use (MOR = 2.425) at the hospital level. After controlling patient- and hospital-level characteristics, a large proportional change in cluster variance was found at the hospital level (PCV 14.7%). Fixed-effect estimation results showed that females, patients aged ≥80 years old, hypertension and dyslipidemia had significant association with the use of PCI. Hospitals with high physician density had a significantly positive relationship with PCI use.ConclusionsPatients receiving care in hospitals located in small areas have equitable access to PCI. Hospital-level variation might be originated from the oversupply of physicians. A balanced number of physicians and beds should be taken into consideration during healthcare allocation. A treatment process guideline on PCI targeting older patients is also needed to ensure a more equitable access for healthcare resources.

Highlights

  • Variation in healthcare delivery among regions and hospitals has been observed worldwide

  • percutaneous coronary intervention (PCI) rates that are represented by secondary medical areas (SMAs) are shown in Fig. 1

  • Our study demonstrates a significant variation (MOR 2.266) in the use of PCI among hospitals, such variation was not observed across secondary medical areas (SMAs)

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Summary

Introduction

Variation in healthcare delivery among regions and hospitals has been observed worldwide. It has been posited that these variations in healthcare delivery can be explained by patient demographics and by the influence of healthcare supply that is characterized at the regional and hospital levels. Studies have consistently suggested that there is variation in, and that geographical characteristics contribute to, health-care delivery and physician preference in clinical decisionmaking. Variation in health care delivery among regions and hospitals has been observed worldwide and reported to have resulted in health inequalities.

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