Coronary disease & ACSCohort study
Impact of the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act on Quality and Outcomes of Major Cardiovascular Procedures Among Veterans
- Retrospective cohort study
- difference-in-differences
Authors' conclusion
MISSION Act implementation was associated with substantial decreases in travel times among veterans who became geographically eligible for non-VA care. For these patients undergoing PCI or CABG, MISSION Act implementation was also associated with worsened 30-day MACE rates.
Study context
- Population
- Veterans receiving nonemergent/nonurgent percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or aortic valve replacement (AVR) in non-VA hospitals under MISSION Act coverage or Veterans Affairs (VA) hospitals, 48 contiguous US states or DC, October 2016–September 2022PCI 43,000
- Exposure
- Veterans living far (>60 min) from nearest VA medical center (eligible for non-VA care under MISSION Act) vs near (≤60 min), before vs after MISSION implementation
- Outcome
- MACE (rehospitalization for CV cause or mortality within 30 days of procedure) and travel times for care
- Follow-up
- 30 days
Main finding
As reported in the abstract
Near
increased by 1.3 minutes
PCI travel time change · CABG travel time change increased by 9.4 minutes · AVR travel time change increased by 10.0 minutes · PCI major adverse cardiovascular events (MACE) change decreased by 0.5 percentage points · CABG MACE change decreased by 6.5 percentage points
Far
decreased by 29.2 minutes
PCI travel time change · CABG travel time change decreased by 18.1 minutes · AVR travel time change decreased by 23.0 minutes · PCI MACE change increased by 2.3 percentage points · CABG MACE change increased by 1.6 percentage points
- PCI travel time
- difference in differences −30.5 minutes; P < 0.001
- CABG travel time
- difference in differences −27.4 minutes; P < 0.001
- AVR travel time
- difference in differences −33.1 minutes; P < 0.001
- PCI 30-day MACE
- difference in differences 2.8 percentage points; P < 0.001
- CABG 30-day MACE
- difference in differences 8.1 percentage points; P < 0.001
- AVR MACE rates not statistically different between the groups
- P = 0.45
Observational data: associations, not effects.
Original publication
Summarised from the published abstract; every number is checked against it