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Medical Care Research and Review
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Article

Trends During 1993-2004 in the Availability and Use of Revascularization After Acute Myocardial Infarction in Markets Affected by Certificate of Need Regulations

Mary S. Vaughan Sarrazin, PhD*, Levent Bayman, and Peter Cram

* To whom correspondence should be addressed. E-mail: mary-vaughan-sarrazin{at}UIOWA.edu.


  Abstract
This study examines trends in the diffusion of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) during 1993-2004 for patients with acute myocardial infarction in markets with and without Certificate of Need (CON) regulations for open-heart surgery or cardiac catheterization and in markets that repealed CON for either of these procedures. In contrast to prior studies, this study accounts for regional hospital markets that cross state boundaries—often with different CON activities in each state. The overall use of CABG increased modestly throughout the 1990s and subsequently decreased, corresponding to a dramatic increase in PCI. There was a greater rise in the number of CABG programs in markets with significant reduction in CON regulations during 1993-2004 compared with other markets, but CON reduction was not related to growth of PCI programs. Reimbursement, ease of use, clinician endorsement, and technological advances in PCI may outweigh effects of CON.

First published on October 12, 2009
Medical Care Research and Review 2009, doi:10.1177/1077558709346565
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