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  1. Regionalization of cardiac surgery in the United States and Canada : geographic access, choice, and outcomes.

    Article - En anglais

    Objective

    - To determine how regionalization of facilities for coronary artery bypass surgery (CABS) affects geographic access to CABS and surgical outcomes.

    Design

    - Computedzed hospital discharge records were used to measure hospital CABS volume and in-hospital post-CABS mortality rates.

    Relationships between surgical volume and age-and sex-adjusted mortality rates were compared using khi2 tests.

    Small-area analysis of the association between CABS rates and distances to nearest CABS hospital was performed using multivariate linear regression methods.

    Results

    - In New York and Canada, approximately 60% of all CABS operations took place in hospitals performing 500 or more CABS operations per year, compared with only 26% in California.

    The highest mortality rates were found among California hospitals performing fewer than 100 CABS operations per year.

    The percentage of the population residing within 25 miles of a CABS hospital was 91% in California, 82% in New York, and less than 60% in Canada.

    Eliminating very low-volume CABS hospitals in California would increase travel distances to a CABS hospital only slightly for a small number of residents.

    Conclusion

    - Regionalization of CABS facilities in New York and Canada largely avoids the problem of low-volume outlier hospitals with high postoperative mortality rates found in California.

    New York has avoided the redundancy of facilities that exists in California while still providing res.

    Mots-clés Pascal : Cardiopathie coronaire, Chirurgie, Hôpital, Régional, Répartition géographique, Canada, Traitement, Homme, Etats Unis, Amérique du Nord, Amérique, Appareil circulatoire pathologie, Organisation santé

    Mots-clés Pascal anglais : Coronary heart disease, Surgery, Hospital, Regional, Geographic distribution, Canada, Treatment, Human, United States, North America, America, Cardiovascular disease, Public health organization

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 96-0004229

    Code Inist : 002B30A04D. Création : 01/03/1996.