[Too many coronary intervention centres in the Netherlands].
The Dutch Minister of Health's decision to expand the number of specialised treatment centres for percutaneous cardiac interventions (PCI) will reduce the volume per centre and per cardiologist. Hospitals and cardiologists have overestimated their adherence region and this will result in too few interventions per cardiologist to allow them to maintain their skills and guarantee optimal quality. Several studies show that there is a strong relationship between volume and complications. In acute PCI, experienced cardiologists have 42% (95% CI: 0.39-0.86) less mortality than their less experienced colleagues. The minister has defended his policy by stating that quality of care is the responsibility of cardiologists, directors of hospitals and health insurance companies. However, the branch is not able to control the distribution of complicated interventions. Although they know that there is a strong relation between the number of interventions and outcome they refuse to accept this and ignore the importance of forming strong alliances and collaborative networks.
Julius Centrum voor Gezondheidswetenschappen en Eerstelijns Geneeskunde, Amsterdam, The Netherlands. y.vandergraaf@umcutrecht.nl
Yolanda
Y
van der Graaf
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000706:statistics & numerical data*; D002300:Cardiac Care Facilities; D002309:Cardiology / Q000592:standards*; D016507:Cardiology Service, Hospital; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D006801:Humans; D017202:Myocardial Ischemia / Q000401:mortality / Q000628:therapy*; D009426:Netherlands; D016896:Treatment Outcome