Practice Pattern Variation in Adoption of New and Evolving Percutaneous Coronary Intervention Procedures
Objective. Assess factors contributing to variation in the use of new and evolving diagnostic and interventional procedures for percutaneous coronary intervention (PCI). Background. Evidence-based practices for PCI have the potential to improve outcomes but are variably adopted. Finding possible dri...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Hindawi-Wiley
2023-01-01
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| Series: | Journal of Interventional Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2023/2488045 |
| _version_ | 1797829056632193024 |
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| author | Diana Naranjo Jacob Doll Charles Maynard Kristine Beaver Aasthaa Bansal Christian D. Helfrich |
| author_facet | Diana Naranjo Jacob Doll Charles Maynard Kristine Beaver Aasthaa Bansal Christian D. Helfrich |
| author_sort | Diana Naranjo |
| collection | DOAJ |
| description | Objective. Assess factors contributing to variation in the use of new and evolving diagnostic and interventional procedures for percutaneous coronary intervention (PCI). Background. Evidence-based practices for PCI have the potential to improve outcomes but are variably adopted. Finding possible drivers of PCI procedure-use variability is key for efforts aimed at establishing more uniform practice. Methods. Veterans Affairs Clinical Assessment, Reporting, and Tracking Program data were used to estimate a proportion of variation attributable to hospital-, operator-, and patient-level factors across (a) radial arterial access, (b) intravascular imaging/optical coherence tomography, and (c) atherectomy for PCI. We used random-effects models with hospital, operator, and patient random effects. Overlap between levels generated cumulative variability estimates greater than 100%. Results. A total of 445 operators performed 95,391 PCI procedures across 73 hospitals from 2011 to 2018. The rates of all procedures increased over this time. 24.45% of variability in the use of radial access was attributable to the hospital, 53.04% to the operator, and 57.83% to patient-level characteristics. 9.06% of the variability in intravascular imaging use was attributable to the hospital, 43.92% to the operator, and 21.20% to the patient. Lastly, 20.16% of the variability in use of atherectomy was attributed to the hospital, 34.63% to the operator, and 57.50% to the patient.Conclusions. The use of radial access, intracoronary imaging, and atherectomy is influenced by patient, operator, and hospital factors, but patient and operator-level effects predominate. Efforts to increase the use of evidence-based practices for PCI should consider interventions at these levels. |
| first_indexed | 2024-04-09T13:15:20Z |
| format | Article |
| id | doaj.art-2cff4ae1ee3c4096891c6db0a37a1c9c |
| institution | Directory Open Access Journal |
| issn | 1540-8183 |
| language | English |
| last_indexed | 2024-04-09T13:15:20Z |
| publishDate | 2023-01-01 |
| publisher | Hindawi-Wiley |
| record_format | Article |
| series | Journal of Interventional Cardiology |
| spelling | doaj.art-2cff4ae1ee3c4096891c6db0a37a1c9c2023-05-12T00:00:04ZengHindawi-WileyJournal of Interventional Cardiology1540-81832023-01-01202310.1155/2023/2488045Practice Pattern Variation in Adoption of New and Evolving Percutaneous Coronary Intervention ProceduresDiana Naranjo0Jacob Doll1Charles Maynard2Kristine Beaver3Aasthaa Bansal4Christian D. Helfrich5Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS)Health Services Research & Development (HSR&D)Health Services Research & Development (HSR&D)Health Services Research & Development (HSR&D)Department of Health Systems and Population HealthHealth Services Research & Development (HSR&D)Objective. Assess factors contributing to variation in the use of new and evolving diagnostic and interventional procedures for percutaneous coronary intervention (PCI). Background. Evidence-based practices for PCI have the potential to improve outcomes but are variably adopted. Finding possible drivers of PCI procedure-use variability is key for efforts aimed at establishing more uniform practice. Methods. Veterans Affairs Clinical Assessment, Reporting, and Tracking Program data were used to estimate a proportion of variation attributable to hospital-, operator-, and patient-level factors across (a) radial arterial access, (b) intravascular imaging/optical coherence tomography, and (c) atherectomy for PCI. We used random-effects models with hospital, operator, and patient random effects. Overlap between levels generated cumulative variability estimates greater than 100%. Results. A total of 445 operators performed 95,391 PCI procedures across 73 hospitals from 2011 to 2018. The rates of all procedures increased over this time. 24.45% of variability in the use of radial access was attributable to the hospital, 53.04% to the operator, and 57.83% to patient-level characteristics. 9.06% of the variability in intravascular imaging use was attributable to the hospital, 43.92% to the operator, and 21.20% to the patient. Lastly, 20.16% of the variability in use of atherectomy was attributed to the hospital, 34.63% to the operator, and 57.50% to the patient.Conclusions. The use of radial access, intracoronary imaging, and atherectomy is influenced by patient, operator, and hospital factors, but patient and operator-level effects predominate. Efforts to increase the use of evidence-based practices for PCI should consider interventions at these levels.http://dx.doi.org/10.1155/2023/2488045 |
| spellingShingle | Diana Naranjo Jacob Doll Charles Maynard Kristine Beaver Aasthaa Bansal Christian D. Helfrich Practice Pattern Variation in Adoption of New and Evolving Percutaneous Coronary Intervention Procedures Journal of Interventional Cardiology |
| title | Practice Pattern Variation in Adoption of New and Evolving Percutaneous Coronary Intervention Procedures |
| title_full | Practice Pattern Variation in Adoption of New and Evolving Percutaneous Coronary Intervention Procedures |
| title_fullStr | Practice Pattern Variation in Adoption of New and Evolving Percutaneous Coronary Intervention Procedures |
| title_full_unstemmed | Practice Pattern Variation in Adoption of New and Evolving Percutaneous Coronary Intervention Procedures |
| title_short | Practice Pattern Variation in Adoption of New and Evolving Percutaneous Coronary Intervention Procedures |
| title_sort | practice pattern variation in adoption of new and evolving percutaneous coronary intervention procedures |
| url | http://dx.doi.org/10.1155/2023/2488045 |
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