Center for Health Statistics
Texas Health Care Information Collection

Utilization Review: Specific Inpatient Procedures by Texas Hospital Referral Region, 2010

A PTCA is performed on patients with coronary artery disease by threading a slender balloon-tipped tube to a trouble spot in the artery of the heart. The balloon is then inflated so that blood can flow more easily. Often an expandable mental stent, a wire mesh tube, is inserted to prop open arteries after PTCA.

Why is this measure important?
PTCA is a potentially over-used procedure, and utilization rates vary widely and systematically between region. The performance of PTCA is a specialized procedure that may have harmful effects for the patient if not carried out well. Evidence shows that hospitals with higher volumes of PTCA have better outcomes, such as fewer deaths or need for coronary artery bypass grafts. However, volume indicators should not be used as the only measure of quality for a hospital; patients should also consider the hospital's mortality rates and overall quality of cardiac care.

Why might there be variation?
PTCA rates vary widely and systematically between areas. Referral patterns, patient and physician preference may play a role in this variation. Clinical factors that are appropriate indications for PTCA may be more prevalent in areas with an older age structure or higher rates of smoking or hyperlipidemia (high blood cholesterol and triglycerides). Hospitals in the region may be referral centers for the procedure. Patients may come from outside the area to receive their procedures at hospitals in the region.

What does this measure tell us?
The graphs and tables in this section show:

• A geographical representation of angioplasty rates by Hospital Referral Region.
• A chart and table presentation of the PTCA rates for the Hospital Referral Regions.
• Charts showing the volume and mortality rates for PTCA at Texas hospitals.  Risk adjusted rate and volume to be added summer 2012.
• Utilization of PTCA procedures in 2007.

These measures are calculated by comparing the total number of non-maternal discharges age 40 and over who had a PTCA procedure with the total population in the hospital referral region age 40 and over. The numerator excludes discharges related to pregnancy and childbirth.
PTCA has been identified as a potentially over-used procedure and, therefore, more average rates may represent better quality care.