Abstract
Abstract P153: Factors Influencing Admissions to America's Lowest Performing Hospitals for AMI Care
Circulation Cardiovascular quality and outcomes, Vol.4(suppl_1)
11/2011
DOI: 10.1161/circoutcomes.4.suppl_1.AP153
Abstract
Background
Research has identified a group of hospitals with consistently poor performance for acute myocardial infarction (AMI) care as compared to other US hospitals. Factors influencing patients' selection of these hospitals are unknown.
Methods
We used 2004-06 Hospital Compare data to identify hospitals reporting AMI process performance measures. We calculated composite AMI performance scores and classified hospitals as low performing (lowest score decile for all 3 years, n = 100), top performing (top score decile for all 3 years, n = 64) and intermediate (all others, n = 2595). We used 2004-05 Medicare data to identify AMI patients living within 5 miles of low performing hospitals and alternative hospitals within 30 miles of patient residence. We used conditional multinomial logit models to evaluate the likelihood of choosing a low performing hospital over alternative hospitals. Models accounted for distance from patient residence to available hospitals, provision of revascularization (based on Medicare CABG volumes), and patient characteristics including age, race and residential social disadvantage (derived from US Census data).
Results
AMI patients admitted to low performing hospitals were older (mean age 80 vs. 79, p <.01), more likely female (56% vs. 51%, p < .01). These patients were more likely to live in zip codes with high (top quartile) social disadvantage (46% vs. 34%, p<.01) and closer to a low performing hospital (1.6 vs. 2.9 miles, p < .01). In multivariate models adjusting for distance and the presence of hospital revascularization services, patients were overall
less
likely to be admitted to low performing hospitals over alternative hospitals (HR 0.28, 95%CI 0.25 - 0.31, p < .01). However, patients living in areas with high disadvantage were
relatively more
likely to be admitted to low performing hospitals as compared to patients from intermediate and low disadvantage areas (HR 2.72 95% CI 2.24 - 3.30, p < .01), even after adjusting for age, race, and sex.
Conclusion
AMI patients are less likely to seek care at low performing hospitals except patients who live in zip code areas with high social disadvantage. Disincentives for poor performance against low performing hospitals could adversely impact care for this vulnerable population.
Details
- Title: Subtitle
- Abstract P153: Factors Influencing Admissions to America's Lowest Performing Hospitals for AMI Care
- Creators
- Saket Girotra - University of IowaMary S Vaughan-Sarrazin - University of IowaPeter Cram - University of IowaIoana Popescu - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Circulation Cardiovascular quality and outcomes, Vol.4(suppl_1)
- DOI
- 10.1161/circoutcomes.4.suppl_1.AP153
- ISSN
- 1941-7713
- eISSN
- 1941-7705
- Language
- English
- Date published
- 11/2011
- Academic Unit
- Health Management and Policy; Cardiovascular Medicine; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984363430202771
Metrics
3 Record Views