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Effects of Percutaneous Coronary Intervention Lab Openings and Closures on Patients, Hospitals, and Communities

Award Number: R01HL114822
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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OTHER PROJECT INFORMATION – Project Summary/Abstract Effects of Percutaneous Coronary Intervention Lab Openings & Closures on Patients, Hospitals &Communities Access to cardiac technology such as percutaneous coronary intervention (PCI) labs is critical to improving population health. Yet we and others have documented that the proliferation of PCI labs tends to concentrate among affluent communities, and untimely access tends to concentrate among low-income communities. Such differential diffusion and closure patterns across communities may widen gaps in disparities between vulnerable communities and other communities. Moreover, proliferation of PCI labs might lead to fewer procedures performed at each site, especially in markets that already have high PCI capacity at baseline, which could lead to worse outcomes. Our primary goal is to identify how openings and closures of PCI labs affect resource allocation and patient health in saturated and low-capacity markets, and whether these market activities disproportionately affect vulnerable populations. Our central hypothesis is that uneven proliferation and closures of PCI facilities affects population health through the following pathways: (1) at the community level, they cause widening gaps in resource allocation between communities that already have high PCI capacity and those that still have unmet need; (2) at the hospital level, they change PCI volume in such a way that could result in worse health outcomes for patients with cardiac conditions; and (3) at the individual patient level, they redistribute patients and widen gaps in access, treatment, and health outcomes between vulnerable and other patients. Aims 1 and 2 address the average effect of PCI lab access change among patients with different conditions (AMI and stable CAD), while Aim 3 addresses the differential effect between vulnerable and other groups. We will link several major databases to address our research questions. First, the primary data with which we will identify the patient cohort will be the 100% Medicare Provider and Analysis Review and Part B claims between 2005 and 2014. Second, we will identify PCI lab availability using the primary data source of the American Hospital Association (AHA) annual surveys for the same years. Third, we have obtained primary data to identify additional hospital characteristics from the AHA surveys and the Healthcare Cost Report Information System. Fourth, we will use 2010 U.S. Census and American Community Surveys to identify each ZIP code community's demographic composition, and the Area Resource File for capturing additional health care market resources at the county level. Last, we will derive two databases that identify (1) baseline PCI capacity for each community and (2) the nearest PCI lab for each patient's ZIP code and corresponding driving time. By providing direct evidence of how changes in PCI access affect health outcomes of patients with AMI and stable CAD in different communities, this research will inform policymakers about the implications of PCI proliferation and closures at community, hospital, and individual levels.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = -$2 )
2024	2020	NATIONAL BUREAU OF ECONOMIC RESEARCH INC	1050 MASSACHUSETTS AVE	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Cardiovascular Diseases Research	000	8	12/28/2023	NON-COMPETING CONTINUATION	-$2
														Subtotal = -$2

Issue Date FY: 2022 ( Subtotal = $0 )
2022	2020	NATIONAL BUREAU OF ECONOMIC RESEARCH, INC.	1050 MASSACHUSETTS AVE	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Cardiovascular Diseases Research	000	8	5/2/2022	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2020 ( Subtotal = $396,588 )
2020	2020	NATIONAL BUREAU OF ECONOMIC RESEARCH, INC.	1050 MASSACHUSETTS AVE	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Cardiovascular Diseases Research	000	8	5/18/2020	NON-COMPETING CONTINUATION	$396,588
														Subtotal = $396,588

Issue Date FY: 2019 ( Subtotal = $393,671 )
2019	2019	NATIONAL BUREAU OF ECONOMIC RESEARCH, INC.	1050 MASSACHUSETTS AVE	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Cardiovascular Diseases Research	001	7	4/26/2019	NON-COMPETING CONTINUATION	$393,671
2019	2018	NATIONAL BUREAU OF ECONOMIC RESEARCH, INC.	1050 MASSACHUSETTS AVE	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Cardiovascular Diseases Research	000	6	11/16/2018	NON-COMPETING CONTINUATION	$0
														Subtotal = $393,671

Issue Date FY: 2018 ( Subtotal = $391,254 )
2018	2018	NATIONAL BUREAU OF ECONOMIC RESEARCH, INC.	1050 MASSACHUSETTS AVE	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Cardiovascular Diseases Research	002	6	4/30/2018	NON-COMPETING CONTINUATION	$391,254
2018	2017	NATIONAL BUREAU OF ECONOMIC RESEARCH, INC.	1050 MASSACHUSETTS AVE	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Cardiovascular Diseases Research	001	5	12/9/2017	COMPETING CONTINUATION	$19,743
2018	2015	NATIONAL BUREAU OF ECONOMIC RESEARCH, INC.	1050 MASSACHUSETTS AVE	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Cardiovascular Diseases Research	000	4	12/9/2017	NON-COMPETING CONTINUATION	-$19,743
														Subtotal = $391,254

Issue Date FY: 2017 ( Subtotal = $395,711 )
2017	2017	NATIONAL BUREAU OF ECONOMIC RESEARCH, INC.	1050 MASSACHUSETTS AVE	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Cardiovascular Diseases Research	002	5	7/6/2017	COMPETING CONTINUATION	$395,711
2017	2015	NATIONAL BUREAU OF ECONOMIC RESEARCH, INC.	1050 MASSACHUSETTS AVE	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Cardiovascular Diseases Research	000	4	2/22/2017	NON-COMPETING CONTINUATION	$0
2017	2015	NATIONAL BUREAU OF ECONOMIC RESEARCH, INC.	1050 MASSACHUSETTS AVE	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Cardiovascular Diseases Research	001	4	7/5/2017	NON-COMPETING CONTINUATION	$0
														Subtotal = $395,711

Issue Date FY: 2015 ( Subtotal = $299,968 )
2015	2015	NATIONAL BUREAU OF ECONOMIC RESEARCH	1050 MASSACHUSETTS AVE	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Cardiovascular Diseases Research	000	4	4/29/2015	NON-COMPETING CONTINUATION	$299,968
														Subtotal = $299,968

Issue Date FY: 2014 ( Subtotal = $295,435 )
2014	2014	NATIONAL BUREAU OF ECONOMIC RESEARCH	1050 MASSACHUSETTS AVE	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Cardiovascular Diseases Research	000	3	4/9/2014	NON-COMPETING CONTINUATION	$295,435
														Subtotal = $295,435

Issue Date FY: 2013 ( Subtotal = $286,792 )
2013	2013	NATIONAL BUREAU OF ECONOMIC RESEARCH	1050 MASSACHUSETTS AVE	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Cardiovascular Diseases Research	000	2	5/20/2013	NON-COMPETING CONTINUATION	$286,792
														Subtotal = $286,792

Issue Date FY: 2012 ( Subtotal = $336,704 )
2012	2012	NATIONAL BUREAU OF ECONOMIC RESEARCH	1050 MASSACHUSETTS AVE	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Cardiovascular Diseases Research	000	1	8/16/2012	NEW	$336,704
														Subtotal = $336,704

Grand Total All Awards = $2,796,121

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Effects of Percutaneous Coronary Intervention Lab Openings and Closures on Patients, Hospitals, and Communities

Award Number: R01HL114822

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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