Regional variation in coronary angiography rates: the association with supply factors and the role of indication: a spatial analysis

BMC Cardiovascular Disorders

Julian Bleek¹  Ursula Marschall²  Norbert Donner-Banzhoff³  Kathrin Schlößler⁴  Udo Schneider⁵  Dirk Horenkamp-Sonntag⁵  Sebastian Franke⁶  Leonie Sundmacher⁶  Julia Frank-Tewaag⁷  Christian Günster⁸ 

[1] AOK Bundesverband, Berlin, Germany;BARMER, Wuppertal, Germany;Department of Family Medicine / General Practice, Philipps-University of Marburg, Marburg, Germany;Department of Family Medicine / General Practice, Ruhr-University Bochum, Bochum, Germany;Techniker Krankenkasse (TK), Hamburg, Germany;Technische Universität München, Uptown München Campus D, Georg-Brauchle-Ring 60/62, 80992, München, Germany;Technische Universität München, Uptown München Campus D, Georg-Brauchle-Ring 60/62, 80992, München, Germany;Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany;Pettenkofer School of Public Health, Munich, Germany;Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany;

关键词: Coronary heart disease;    Coronary angiography;    Clinical practice variation;    Indication;    Regional analysis;   

DOI  :  10.1186/s12872-022-02513-z

来源: Springer

【 摘 要 】

BackgroundCoronary angiographies (CAs) are among the most common diagnostic procedures carried out in German hospitals, and substantial regional differences in their frequency of use have been documented. Given the heterogeneity with regard to the expected benefits and the varying scope for discretion depending on the indication for the procedure, we hypothesized that the observed variation and the association of need and supply factors differs by indication for CA.MethodsWe investigated the correlation between supply factors and the regional rates of CAs in Germany while controlling for need using spatial‐autoregressive error models (SARE) and spatial cross-regressive models with autoregressive errors (SCRARE). The overall rates of CAs and the rates in specific patient subgroups, namely, patients with and without myocardial infarction (MI), were calculated based on a comprehensive set of nationwide routine data from three statutory health insurances at the district level.ResultsAlthough little variation was found in cases with MI, considerable variation was seen in the overall cases and cases without MI. The SARE models revealed a positive association between the number of hospitals with a cardiac catheterization laboratory per 10,000 population and the rates of overall cases and cases without MI, whereas no such relationship existed in cases with MI. Additionally, an association between regional deprivation and the rates of CAs was found in cases with MI, but no such association was seen in cases without MI.ConclusionsThe results supported the hypothesis that the relative association of need and supply factors differed by the indication for CA. Although the regional differences in the frequency of use of CAs can only be explained in part by the factors examined in our study, it offers insight into patient access to and the provision of CA services and can provide a platform for further local research.

【 授权许可】

CC BY