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Contributors to the growth of same day discharge after elective percutaneous coronary intervention

Contributors to the growth of same day discharge after elective percutaneous coronary intervention
Contributors to the growth of same day discharge after elective percutaneous coronary intervention

BACKGROUND: Financial pressures for reducing hospitalization costs have driven to a move toward same day discharge (SDD) following uncomplicated percutaneous coronary intervention. The UK healthcare system has transitioned to predominantly SDD for elective percutaneous coronary intervention. This study aimed to examine patient's clinical, procedural, and institutional characteristics that are associated with the increased adoption of SDD adoption over time in the United Kingdom and determine whether these vary by region.

METHODS: The data were derived from the British Cardiovascular Intervention Society including all the elective percutaneous coronary intervention from 2007 to 2014 in the United Kingdom. We structured 8 meaningful groups of variables, and their relative importance was obtained by decomposing the R2 in each study year.

RESULTS: The relative importance of Strategic Health Authorities was substantially higher than all other factors every year, with some reduction over time, from 49.2% (95% CI, 45.4%-52.4%) in 2007 to 43.4% (95% CI, 39.9%-46.6%) in 2014. Center volume followed with 8.95% (95% CI, 7.0%-10.9%) to 19.8% (95% CI, 16.7%-22.4%). Between patients' clinical and procedural characteristics, pharmacology and access site had the highest relative importance values, from 14.3% (95% CI, 12.1%-16.4%) to 7.1% (95% CI, 5.5%-8.8%) and from 3.6% (95% CI, 2.3%-5.1%) to 11.8% (95% CI, 9.4%-14.3%), respectively. Relative importance of different groups varied differently across Strategic Health Authorities.

CONCLUSIONS: Growth of SDD was mainly associated with regional characteristics, while subcontributors varied substantially between different regions. Standardized guidelines would provide more homogenous adoption of SDD nationally. This analysis might be of wider interest in healthcare systems slower in SDD adoption.

Strategic Health Authorities, hospitalization, length of stay, percutaneous coronary intervention, stent
1941-7640
Taxiarchi, Paraskevi
94308cb4-c144-4065-a978-92c017cc3d12
Martin, Glen P.
13d12c9e-ada2-4c0c-836d-07af6d1c3ce7
Kinnaird, Tim
3cfe5aa5-eb28-4a4d-b2e4-6ea0799d85d0
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Ahmed, Javed
316ca891-f440-438e-a9f7-6daced46dc32
Ludman, Peter
28ef305d-e09e-40a7-84b4-6ccedfb37cc8
De Belder, Mark
f0106dad-a7dd-4c54-a47e-03ec4c5c826f
Shoaib, Ahmad
87d9fdcb-a5ce-4379-8280-3115040dc364
Rashid, Muhammad
f974c0d2-bd55-4d93-940e-1cce3dd0fd59
Kontopantelis, Evangelos
0a21ca6f-4516-45f8-80fc-b10dd7db6780
Mamas, Mamas A.
b71e6a0a-07a4-4822-a10e-c02a6b29ae5d
Taxiarchi, Paraskevi
94308cb4-c144-4065-a978-92c017cc3d12
Martin, Glen P.
13d12c9e-ada2-4c0c-836d-07af6d1c3ce7
Kinnaird, Tim
3cfe5aa5-eb28-4a4d-b2e4-6ea0799d85d0
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Ahmed, Javed
316ca891-f440-438e-a9f7-6daced46dc32
Ludman, Peter
28ef305d-e09e-40a7-84b4-6ccedfb37cc8
De Belder, Mark
f0106dad-a7dd-4c54-a47e-03ec4c5c826f
Shoaib, Ahmad
87d9fdcb-a5ce-4379-8280-3115040dc364
Rashid, Muhammad
f974c0d2-bd55-4d93-940e-1cce3dd0fd59
Kontopantelis, Evangelos
0a21ca6f-4516-45f8-80fc-b10dd7db6780
Mamas, Mamas A.
b71e6a0a-07a4-4822-a10e-c02a6b29ae5d

Taxiarchi, Paraskevi, Martin, Glen P., Kinnaird, Tim, Curzen, Nick, Ahmed, Javed, Ludman, Peter, De Belder, Mark, Shoaib, Ahmad, Rashid, Muhammad, Kontopantelis, Evangelos and Mamas, Mamas A. (2020) Contributors to the growth of same day discharge after elective percutaneous coronary intervention. Circulation. Cardiovascular interventions, 13 (3), [e008458]. (doi:10.1161/CIRCINTERVENTIONS.119.008458).

Record type: Article

Abstract

BACKGROUND: Financial pressures for reducing hospitalization costs have driven to a move toward same day discharge (SDD) following uncomplicated percutaneous coronary intervention. The UK healthcare system has transitioned to predominantly SDD for elective percutaneous coronary intervention. This study aimed to examine patient's clinical, procedural, and institutional characteristics that are associated with the increased adoption of SDD adoption over time in the United Kingdom and determine whether these vary by region.

METHODS: The data were derived from the British Cardiovascular Intervention Society including all the elective percutaneous coronary intervention from 2007 to 2014 in the United Kingdom. We structured 8 meaningful groups of variables, and their relative importance was obtained by decomposing the R2 in each study year.

RESULTS: The relative importance of Strategic Health Authorities was substantially higher than all other factors every year, with some reduction over time, from 49.2% (95% CI, 45.4%-52.4%) in 2007 to 43.4% (95% CI, 39.9%-46.6%) in 2014. Center volume followed with 8.95% (95% CI, 7.0%-10.9%) to 19.8% (95% CI, 16.7%-22.4%). Between patients' clinical and procedural characteristics, pharmacology and access site had the highest relative importance values, from 14.3% (95% CI, 12.1%-16.4%) to 7.1% (95% CI, 5.5%-8.8%) and from 3.6% (95% CI, 2.3%-5.1%) to 11.8% (95% CI, 9.4%-14.3%), respectively. Relative importance of different groups varied differently across Strategic Health Authorities.

CONCLUSIONS: Growth of SDD was mainly associated with regional characteristics, while subcontributors varied substantially between different regions. Standardized guidelines would provide more homogenous adoption of SDD nationally. This analysis might be of wider interest in healthcare systems slower in SDD adoption.

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More information

Accepted/In Press date: 19 December 2019
e-pub ahead of print date: 10 March 2020
Published date: March 2020
Keywords: Strategic Health Authorities, hospitalization, length of stay, percutaneous coronary intervention, stent

Identifiers

Local EPrints ID: 443330
URI: http://eprints.soton.ac.uk/id/eprint/443330
ISSN: 1941-7640
PURE UUID: 5cb5195f-4d6e-4d47-9570-aaf628657647
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 20 Aug 2020 16:33
Last modified: 28 Apr 2022 01:55

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Contributors

Author: Paraskevi Taxiarchi
Author: Glen P. Martin
Author: Tim Kinnaird
Author: Nick Curzen ORCID iD
Author: Javed Ahmed
Author: Peter Ludman
Author: Mark De Belder
Author: Ahmad Shoaib
Author: Muhammad Rashid
Author: Evangelos Kontopantelis
Author: Mamas A. Mamas

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