Impact of Patient Distance From Percutaneous Coronary Intervention Centers on Longitudinal Outcomes Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

摘要

BACKGROUND: In regional healthcare referral networks, specialty care is provided at a few sites within the network, with patients referred there for management. This model may increase access to specialized care but also increases the distance that patients travel to receive such care, with unknown effects on longitudinal outcomes. The Veterans Administration uses such regional models for percutaneous coronary intervention (PCI). The impact of patient distance from specialty centers on longitudinal outcomes after receipt of specialized care is understudied and may carry implications for care delivery models.METHODS AND RESULTS: We identified 31 483 patients undergoing PCI at 64 Veterans Administration sites between 2008 to 2012, and assessed the relationship between quintile (Qn) of patient distance from PCI center and all-cause death or myocardial infarction within a year of PCI. Secondary analyses investigated interactions between patient distance and PCI presentation, urgency, and Medicare eligibility on the primary outcome. Median distance to PCI site was 48 miles (interquartile range, 17-110). After adjustment, increasing distance from PCI center was not associated with higher risk of 1-year death or myocardial infarction (with Qn1 as reference, Qn2: odds ratio, 1.02 [95% simultaneous Cl, 0.84-1.25]; Qn3: 1.06 [95% simultaneous Cl, 0.87-1.30]; Qn4: 0.92 [95% simultaneous Cl, 0.75-1.14]; Qn5: 0.97 [95% simultaneous Cl, 0.78-1.20]). Stratifying the cohort by acute coronary syndrome presentation, urgency of PCI, and by eligibility for Medicare did not find an association between distance and outcome.CONCLUSIONS: In this cohort of US veterans, 50% traveled 48 miles or longer to undergo PCI, and 25% traveled >110 miles. Despite this wide range of distances traveled, there was no association between patient distance to PCI center and subsequent outcomes of death or myocardial infarction at 1 year. These findings suggest that regional referral networks may represent viable models for PCI care delivery.