Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
To the Editor: Ms Kansagra and colleagues1 concluded that regionalization policies for percutaneous
transluminal coronary angioplasty would not affect patient travel distances.
Although the study and results are compelling, additional analyses may provide
further insight and possibly different findings. Results from New Jersey,
New York, and Florida may not be applicable to other states with lower physician
and population densities. Also, the overall results may not reflect variation
among different regions (eg, Western New York, Florida panhandle) and counties
within the 3 states.Regionalization could have significantly different effects
on rural, suburban, and urban areas that have varying access to physicians
and hospitals. For example, Losina et al2 found
that policies restricting total hip replacements to high-volume centers would
differentially affect poor, less-educated, and rural patients. Stratifying
the analysis by population density, socioeconomic indicators, types of insurance
carriers, and health care professional and facility density may be very valuable.
Lee BY, Shah A, Chen EH. Regionalization of Coronary Angioplasty and Travel Distance. JAMA. 2005;293(3):295–296. doi:10.1001/jama.293.3.295-b