Acute myocardial infarction and coronary artery bypass grafting outcomes in specialty and general hospitals: analysis of state inpatient data

Peter Cram; Levent Bayman; Joanna Popescu; Mary S Vaughan-Sarrazin

doi:10.1111/j.1475-6773.2009.01066.x

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Acute myocardial infarction and coronary artery bypass grafting outcomes in specialty and general hospitals: analysis of state inpatient data

Journal article

Open access

Peer reviewed

Acute myocardial infarction and coronary artery bypass grafting outcomes in specialty and general hospitals: analysis of state inpatient data

Peter Cram, Levent Bayman, Joanna Popescu and Mary S Vaughan-Sarrazin

Health services research, Vol.45(1), pp.62-78

02/2010

DOI: 10.1111/j.1475-6773.2009.01066.x

PMCID: PMC2813437

PMID: 20002764

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Abstract

Compare characteristics and outcomes of patients hospitalized in specialty cardiac and general hospitals for acute myocardial infarction (AMI) and coronary artery bypass grafting (CABG). 2000-2005 all-payor administrative data from Arizona, California, Texas, and Wisconsin. We identified patients admitted to specialty and competing general hospitals with AMI or CABG and compared patient demographics, comorbidity, and risk-standardized mortality in specialty and general hospitals. Specialty hospitals admitted a lower proportion of women and blacks and treated patients with less comorbid illness than general hospitals. Unadjusted in-hospital AMI mortality for Medicare enrollees in specialty and general hospitals was 6.1 and 10.1 percent (p<.0001) and for non-Medicare enrollees was 2.8 and 4.0 percent (p<.04). Unadjusted in-hospital CABG mortality for Medicare enrollees in specialty and general hospitals was 3.2 and 4.7 percent (p<.01) and for non-Medicare enrollees was 1.1 and 1.8 percent (p=.02). After adjusting for patient characteristics and hospital volume, risk-standardized in-hospital mortality for all AMI patients was 2.7 percent for specialty hospitals and 4.1 percent for general hospitals (p<.001) and for CABG was 1.5 percent for specialty hospitals and 2.0 percent for general hospitals (p=.07). In-hospital mortality in specialty hospitals was lower than in general hospitals for AMI but similar for CABG. Our results suggest that specialty hospitals may offer significantly better outcomes for AMI but not CABG.

United States - epidemiology

Acute Disease

Outcome Assessment (Health Care)

Humans

Middle Aged

Male

Hospitals, Special - statistics & numerical data

Databases as Topic

Hospital Mortality - trends

Hospitals, General - standards

Hospitals, Special - standards

Myocardial Infarction

Aged, 80 and over

Coronary Artery Bypass

Female

Aged

Hospitals, General - statistics & numerical data

Insurance, Health

Quality of Health Care

Details

Title: Subtitle: Acute myocardial infarction and coronary artery bypass grafting outcomes in specialty and general hospitals: analysis of state inpatient data
Creators: Peter Cram - Division of General Medicine, University of Iowa Carver College of Medicine, Iowa City VA Medical Center, Mail Stop 152, Iowa City, IA, USA. peter-cram@uiowa.edu
Levent Bayman
Joanna Popescu
Mary S Vaughan-Sarrazin
Resource Type: Journal article
Publication Details: Health services research, Vol.45(1), pp.62-78
DOI: 10.1111/j.1475-6773.2009.01066.x
PMID: 20002764
PMCID: PMC2813437
NLM abbreviation: Health Serv Res
ISSN: 0017-9124
eISSN: 1475-6773
Publisher: United States
Grant note: R01 HL085347 / NHLBI NIH HHS K23 RR019972-01A1 / NCRR NIH HHS K23 RR01997201 / NCRR NIH HHS R01 HL085347-01A1 / NHLBI NIH HHS K08 HL-095930 / NHLBI NIH HHS K08 HL095930 / NHLBI NIH HHS K23 RR019972 / NCRR NIH HHS R01 AG033035 / NIA NIH HHS
Language: English
Date published: 02/2010
Academic Unit: Health Management and Policy; General Internal Medicine; Internal Medicine
Record Identifier: 9984063122902771

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