title: Evidence of systematic duplication by new percutaneous coronary intervention programs.
abstract: BACKGROUND
  Evidence suggests that recent and projected future investments in percutaneous coronary intervention (PCI) programs at US hospitals fail to increase access to timely reperfusion for patients with ST-segment elevation myocardial infarction.
  
  
  RESULTS
  We set out to estimate the annual number and costs of new PCI programs in US hospitals from 2004 to 2008 and identify the characteristics of hospitals, neighborhoods, and states where new PCI programs have been introduced. We estimated a discrete-time hazard model to measure the influence of these characteristics on the decision of a hospital to introduce a new PCI program. In 2008, 1739 US hospitals were capable of performing PCI, a relative increase of 16.5% (251 hospitals) over 2004. The percentage of the US population with projected access to timely PCI grew by 1.8%. New PCI programs were more likely to be introduced in areas that already had a PCI program with more competition for market share, near populations with higher rates of private insurance, in states that had weak or no regulation of new cardiac catheterization laboratories, and in wealthier and larger hospitals.
  
  
  CONCLUSIONS
  Our data show that new PCI programs were systematically duplicative of existing programs and did not help patients gain access to timely PCI. The total cost of recent US investments in new PCI programs is large and of questionable value for patients.
authors.affiliation: The RAND Corporation, Boston, MA 02116, USA. tconcann@rand.org
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Concannon
authors.forename: Jason
authors.initials: J
authors.lastname: Nelson
authors.forename: David M
authors.initials: DM
authors.lastname: Kent
authors.forename: John L
authors.initials: JL
authors.lastname: Griffith
mesh_terms: D019352:Censuses; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000639:trends; D005544:Forecasting; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000639:trends; D006301:Health Services Needs and Demand; D006302:Health Services Research; D017721:Hospital Costs; D006761:Hospitals / Q000639:trends; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D020380:Needs Assessment; D062645:Percutaneous Coronary Intervention / Q000191:economics / Q000639:trends; D016016:Proportional Hazards Models; D012111:Residence Characteristics; D013997:Time Factors; D061665:Time-to-Treatment / Q000191:economics / Q000639:trends; D014481:United States
keywords: ST-segment elevation myocardial infarction; angioplasty; catheterization; mapping; percutaneous coronary intervention