Mobile cardiac catheterization laboratories increase use of cardiac care in women and African Americans

Sketch, Michael H.; Pieper, Karen S.; Warner, John; Daniel, John M.; Wilkerson, Tammey M.; Harrison, J. Kevin; Peterson, Eric D.; Bashore, Thomas M.

doi:10.1016/j.ahj.2007.04.038

« Previous Next »American Heart Journal
Volume 154, Issue 3 , Pages 532-538, September 2007

Mobile cardiac catheterization laboratories increase use of cardiac care in women and African Americans

Michael H. Sketch Jr, MD
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Reprint requests: Michael H. Sketch, Jr, MD, Director, Adult Cardiac Catheterization Laboratories, Duke Hospital, P.O. Box 3157, Durham, NC 27710.
Karen S. Pieper, MS
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
John Warner, MD
- University of Texas Southwestern Medical Center, Dallas, TX
John M. Daniel, BA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
Tammey M. Wilkerson, RN
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
J. Kevin Harrison, MD
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
Eric D. Peterson, MD, MPH
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
Thomas M. Bashore, MD
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC

Received 13 March 2007; accepted 14 April 2007. published online 04 June 2007.

Background

Women and minorities traditionally have shown less use of diagnostic cardiac catheterization. We sought to determine whether mobile cardiac catheterization laboratories may increase the use of catheterization among women and minorities by bringing the technology to remote communities.

Methods

We collected data on consecutive patients undergoing cardiac catheterization at mobile laboratories located at 15 community hospitals in North Carolina and Virginia from 1994 to 2005. These data were compared with those from similar consecutive outpatients at the Duke University Medical Center (Durham, NC) cardiac catheterization laboratory over the same period. Logistic regression modeling techniques were used to determine which patient factors were associated with the decision to use a particular facility.

Results

Women comprised 48% of the patients undergoing cardiac catheterization via mobile laboratory versus 42% of those patients receiving outpatient catheterization at the medical center laboratory (P < .001). All racial minorities combined (African American, Hispanic, Native American, Asian, and other) made up 27% of the mobile laboratory population undergoing catheterization versus 21% of the medical center outpatients who underwent the procedure (P < .001). Most minorities were African American. The most important predictor of patients receiving catheterization via a mobile laboratory rather than at the medical center catheterization laboratory was distance to the nearest mobile facility. Within a home-to-mobile laboratory range of approximately 35 miles, the odds of being treated at a mobile laboratory increased greatly the closer the patient lived to the facility.

Conclusions

The strongest predictor of mobile laboratory use was the patient's proximity to the mobile facility. When compared with a traditional tertiary referral outpatient hospital setting, a greater percentage of women and African Americans received cardiac catheterization at mobile laboratories. The availability of mobile laboratories may increase the use of cardiac procedures among women and African Americans.