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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2007.06.031 Byline: Vivian Ho (a)(b), Joseph S. Ross (c)(d), Brahmajee K. Nallamothu (e), Harlan M. Krumholz (f)(g)(h) Abstract: Many states enforce Certificate of Need (CON) regulations for cardiac procedures, but little is known about how CON affects utilization. We assessed the association between cardiac CON regulations, availability of revascularization facilities, and revascularization rates. Author Affiliation: (a) Baker Institute for Public Policy, Rice University, Houston, TX (b) Department of Medicine, Baylor College of Medicine (c) Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY (d) Geriatrics Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY (e) Health Services Research and Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, MI (f) Department of Medicine, Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, New Haven, CT (g) Department of Epidemiology and Public Health, Section of Health Policy and Administration, Yale University School of Medicine, New Haven, CT (h) Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT Article History: Received 29 January 2007; Accepted 19 June 2007 Article Note: (footnote) Dr Ross was a scholar in the Robert Wood Johnson Clinical Scholars Program at Yale University sponsored by the Robert Wood Johnson Foundation at times during his involvement in the project., Support was given from a grant awarded to Dr Ho by the National Heart, Lung, and Blood Institute (R01 HL073825-01A1).

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2007.04.052 Byline: Catherine Kim (a)(b), Ana V. Diez Roux (c), Timothy P. Hofer (d)(e), Brahmajee K. Nallamothu (d)(f), Steven J. Bernstein (d)(f), Mary A.M. Rogers (g) Abstract: Individuals of low socioeconomic status (SES) have reduced access to coronary artery bypass graft surgery (CABG). It is unknown if low-SES CABG patients have reduced access to hospitals with better outcomes. Author Affiliation: (a) Division of General Internal Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI (b) Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (c) Department of Epidemiology, Robert Wood Johnson Health and Society Scholars Program, University of Michigan School of Public Health, Ann Arbor, MI (d) Department of Veterans Affairs, VA Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI (e) Department of Internal Medicine, Michigan Diabetes Research and Training Center, The Robert Wood Johnson Clinical Scholars Program, University of Michigan, School of Medicine, Ann Arbor, MI (f) Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI (g) Division of General Internal Medicine, Department of Medicine, Patient Safety Enhancement Program, University of Michigan School of Medicine, Ann Arbor, MI Article History: Received 29 January 2007; Accepted 1 April 2007 Article Note: (footnote) This study was supported by a grant from the Robert Wood Johnson Health and Society Scholars Program, the American Diabetes Association, and NIDDK K23-DK071552.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2007.01.006 Byline: Ali Mahajerin (a), Hitinder S. Gurm (a), Thomas T. Tsai (a), Paul S. Chan (a), Brahmajee K. Nallamothu (a)(b) Abstract: The use of vasodilators to improve long-term outcomes in asymptomatic patients with chronic aortic insufficiency (AI) is controversial. Author Affiliation: (a) Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI (b) Health Services Research and Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, MI Article History: Received 18 November 2006; Accepted 10 January 2007

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2006.03.025 Byline: Brahmajee K. Nallamothu (a)(b), Paul A. Taheri (c), William G. Barsan (d), Eric R. Bates (b) Abstract: Many cardiovascular experts have called for the creation of specialized myocardial infarction centers and networks in the United States analogous to the current model for major trauma. Patients suffering ST-elevation myocardial infarction (STEMI) and trauma share an essential feature that makes the argument for regionalization persuasive: rapid triage and treatment by highly trained personnel improve survival in both conditions. Despite this similarity, however, the trauma system may be limited as a model for regionalizing STEMI care. First, the development of trauma systems has been hindered by the struggle for sufficient and stable funding, competing interests among individual stakeholders, and the overall lack of desire for state-sponsored healthcare planning in the United States. These same obstacles would need to be overcome if STEMI care is regionalized. Second, unique characteristics related to STEMI care, such as its varied clinical presentation and more lucrative reimbursement, will create new challenges. In this article, we briefly review the current status of trauma systems in the United States and describe why the regionalization of STEMI care may require different methods of healthcare organization. Author Affiliation: (a) Health Services Research and Development Center of Excellence, VA Medical Center, Ann Arbor, MI (b) Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI (c) Section of Trauma Burn and Critical Care, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI (d) Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI Article History: Received 21 December 2005; Accepted 20 March 2006 Article Note: (footnote) Conflicts of Interest Disclosures: The authors have no potential conflicts of interests that affected the reporting of this work., Dr Nallamothu is being supported as a clinical scholar under a K12 grant from the National Institutes of Health (RR017607-01) and a grant by the Mardigian Foundation.

Background: The number of peripheral vascular intervention (PVI) procedures performed is steadily increasing in the United States. PVD-QI2 is a prospective, multicenter observational study designed to improve the quality of care for patients undergoing PVI and to better understand the effectiveness and appropriateness of PVI in improving outcomes of peripheral arterial disease. The registry aims to elucidate which comorbid conditions and procedure-related variables are associated with beneficial or adverse outcomes after vascular interventions. Methods: Five centers are currently prospectively collecting data on consecutive PVIs performed at their institutions and will include patients with both claudication and critical limb ischemia. A common data collection form and a standard set of definitions were developed during several planning meetings. Information on patient demographics, clinical history, comorbid conditions, treatment approaches, and inhospital outcomes are being collected. Patients will be followed up at 30 days, 6 months, and 1 year after each procedure to identify recurrent vascular events, medication use, lifestyle modifications (regular exercise, dietary modification), self-reported walking scores, and mortality. Data validity will be assured through review of data form accuracy by a trained nurse, by automatic database diagnostic routines, and by site visits that include review of angiography suite logs and randomly selected charts. Conclusions: The development of a quality-controlled PVI registry requires the commitment and collaboration of clinician-investigators and hospital systems devoted to understanding factors that contribute to quality outcomes. Central to achievement of this goal is the creation of a careful diagnostic and data quality assessment system. This registry will provide important clinical insights into patient demographic and clinical characteristics, procedural characteristics, and current practice patterns that foster or impede achievement of long-term quality-based clinical outcomes for patients with peripheral arterial disease. [Copyright &y& Elsevier]