Primary percutaneous coronary intervention expansion to hospitals without on-site cardiac surgery in Michigan: a geographic information systems analysis.
BACKGROUND
In 2005, Michigan expanded primary percutaneous coronary intervention (P-PCI) capability to 12 hospitals without on-site cardiac surgery. We determined the potential impact of this expansion on geographic access to P-PCI for patients.


METHODS
Geographic information systems using the US Census Survey and hospital data from the state of Michigan were used to construct maps with 20-mile hospital service areas around P-PCI hospitals with and without on-site cardiac surgery. Geographic access was calculated as the percentage of the population living within the hospital service areas of these 2 types of hospitals.


RESULTS
Of 9,938,444 persons in Michigan, 7,694,834 (77.4%) lived within 20 miles of a P-PCI hospital. Thirty centers with on-site cardiac surgery provided access for 7,219,995 persons (72.6%). The 12 P-PCI hospitals without on-site cardiac surgery increased access by 474,839 persons (4.8%). Of these, 3 geographically isolated facilities, which were at least 20 miles away from another P-PCI hospital, accounted for the greatest improvement in geographic access (n = 425,700 [4.3%]), whereas the remaining 9 hospitals increased access by only 49,139 persons (0.5%).


CONCLUSIONS
Expansion of P-PCI to hospitals without on-site cardiac surgery in Michigan improved geographic access to a modest extent.
Buckley
Jeremy W
JW
University of Michigan Medical School, Ann Arbor, MI 48109, USA. buckley@umich.edu
Bates
Eric R
ER
Nallamothu
Brahmajee K
BK
D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D040362:Geographic Information Systems; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D008824:Michigan; D009203:Myocardial Infarction / Q000628:therapy*; D013503:Surgery Department, Hospital; D013903:Thoracic Surgery