title: Characteristics of Early and Late Adopting Hospitals Providing Percutaneous Coronary Intervention in Taiwan.
abstract: BACKGROUND
  Studies in the United States suggested that the characteristics of hospitals providing percutaneous coronary intervention (PCI) differed from those not providing PCI. However, little is known on the differences between the characteristics of early-adopting hospitals and those of late-adopting hospitals, and on their potential impacts on PCI volume and access.
  
  
  RESULTS
  We used inpatient claims data from 1997 to 2012 from the Taiwan National Health Insurance program to identify the hospitals offering PCI. Geographic information systems (GIS) were used to determine the population access to PCI hospital. As of 2012, 88 hospitals were capable of providing PCI. On the basis of the year that the hospitals started providing PCI, 32 hospitals were designated as early adopters (before 1998), 23 as early majority (1998-2002), 24 as late majority (2003-2007), and 16 as laggards (2008-2012). Hospitals that adopted PCI later were smaller in size and closer to an existing PCI hospital and had lower PCI volumes performed and less bypass surgery support. The median PCI volumes in 2012 were n=706, 330, 138, and 81 in early adopters, early majority, late majority, and laggards, respectively. Despite the low volume of PCI performed in laggard hospitals, the percentage with ST-elevation myocardial infarction and acute myocardial infarction as principal discharge diagnosis was higher than their early-adopting hospital counterparts. The percentage of the Taiwanese population living within 40 km of PCI hospitals (appropriate access defined in this study) was 95.7% in 1997 and 98.0% in 2002, and this has remained unchanged since 2002.
  
  
  CONCLUSIONS
  The characteristics of early-adopting hospitals differed from those of late-adopting hospitals. Despite lower PCI volume performed in late-adopting hospitals, many of them are in remote areas and provide needed and timely services for patients with acute myocardial infarction.
authors.affiliation: Department of Public Health, National Cheng Kung University, Tainan, Taiwan (T.H.L., J.C.L., F.W.L.).
authors.forename: Tsung-Hsueh
authors.initials: TH
authors.lastname: Lu
authors.affiliation: Program in Ageing and Long-term Care, Kaohsiuang Medical University, Kaohsiung, Taiwan (Y.T.H.).
authors.forename: Yu-Tung
authors.initials: YT
authors.lastname: Huang
authors.affiliation: Department of Public Health, National Cheng Kung University, Tainan, Taiwan (T.H.L., J.C.L., F.W.L.).
authors.forename: Jo-Chi
authors.initials: JC
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan (L.T.Y.).
authors.forename: Li-Tan
authors.initials: LT
authors.lastname: Yang
authors.affiliation: Department of Public Health, National Cheng Kung University, Tainan, Taiwan (T.H.L., J.C.L., F.W.L.).
authors.forename: Fu-Wen
authors.initials: FW
authors.lastname: Liang
authors.affiliation: Division of Cardiology, Cheng Hsin General Hospital and Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan (W.H.Y.).
authors.forename: Wei-Hsian
authors.initials: WH
authors.lastname: Yin
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Harvard University, Boston, MA (I.K.).
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
mesh_terms: D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data; D004059:Diffusion of Innovation; D040362:Geographic Information Systems; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D013624:Taiwan
keywords: access to care; angioplasty; diffusion of innovation; geographic information system; mapping; percutaneous coronary intervention