title: Cardiologist service volume, percutaneous coronary intervention and hospital level in relation to medical costs and mortality in patients with acute myocardial infarction: a nationwide study.
abstract: BACKGROUND
  We explore whether cardiologist service volume, hospital level and percutaneous coronary intervention (PCI) are associated with medical costs and acute myocardial infarction (AMI) mortality.
  
  
  METHODS
  From the 1997-2010 Taiwan National Health Insurance Research Database of the National Health Research Institute, we identified AMI patients and performed multiple regression analyses to explore the relationships among the different hospital levels and treatment factors.
  
  
  RESULTS
  We identified 2942 patients with AMI in medical centers and 4325 patients with AMI in regional hospitals. Cardiologist service volume, performing PCI and medical costs per patient were higher in medical centers than in regional hospitals (P < 0.0001). However, the two hospital levels did not differ significantly in in-hospital mortality (P = 0.1557). Post hoc analysis showed significant differences in in-hospital mortality rate and in medical costs among the eight groups subdivided on the basis of hospital level, cardiologist service volume, and whether PCI was performed (P < 0.001 and P = 0.001, respectively).
  
  
  CONCLUSIONS
  These results highlight the importance of encouraging hospitals to develop PCI capability and increase their cardiologist service volume after taking medical costs into account. Transferring AMI patients to hospitals with higher cardiologist service volume and PCI performed can also be very important.
authors.affiliation: From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: C-Y
authors.initials: CY
authors.lastname: Liu
authors.affiliation: From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Y-N
authors.initials: YN
authors.lastname: Lin
authors.affiliation: From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: C-L
authors.initials: CL
authors.lastname: Lin
authors.affiliation: From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Chang
authors.affiliation: From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, C
authors.forename: Y-H
authors.initials: YH
authors.lastname: Hsu
authors.affiliation: From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan d10040@mail.cmuh.org.tw wtsai@mail.cmu.edu.tw.
authors.forename: W-C
authors.initials: WC
authors.lastname: Tsai
authors.affiliation: From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan d10040@mail.cmuh.org.tw wtsai@mail.cmu.edu.tw.
authors.forename: C-H
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D016507:Cardiology Service, Hospital / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000191:economics / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000191:economics / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology; D016526:Workload / Q000706:statistics & numerical data