TY - JOUR
T1 - Association of insurance status with inpatient treatment for coronary artery disease
T2 - Findings from the Get With the Guidelines program
AU - Vidovich, Mladen I.
AU - Vasaiwala, Samip
AU - Cannon, Christopher P.
AU - Peterson, Eric D.
AU - Dai, David
AU - Hernandez, Adrian F.
AU - Fonarow, Gregg C.
N1 - Funding Information:
The authors had full access to and take full responsibility for the integrity of the data. All authors have read and agree to the manuscript as written. The authors are solely responsible for the design and conduct of this study, all study analyses and drafting and editing of the manuscript. This work was supported by the AHA/GWTG Young Investigator Database Seed Grant. The GWTG Project is supported by the AHA in part through an unrestricted education grant from Merck-Schering Plough Partnership who did not participate in the design, analysis, or manuscript preparation.
PY - 2010/6
Y1 - 2010/6
N2 - Background: Prior studies have documented that patients' health insurance status can impact use of guideline-based care as well as acute outcomes for coronary artery disease. Whether insurance status remains a contemporary influence among centers participating in a national quality improvement initiative is unknown. Methods: We analyzed data from 237,779 admissions with coronary artery disease from 527 hospitals participating in the Get With The Guidelines-Coronary Artery Disease Program from 2000 to 2008. Insurance status was Medicare (48.8%), Private/Health Maintenance Organization (HMO) (34.9%), Medicaid (8.2%), and No Insurance Documented (NID) (8.2%). Quality of care was measured using standard quality indicators covering acute treatment and discharge measures, utilization of invasive procedures, length of stay, and mortality. Relationship between different insurance types was examined using generalized estimating equation logistic regression and propensity-score matching adjusting for demographics, comorbidities and hospital characteristics. Results: After propensity matching, full compliance with all eligible measures (deficit-free care) relative to Private/HMO was lower for Medicare (P < .0001) and Medicaid (P < .0001) and higher for the NID group (P = .0312). The acute reperfusion times were comparable among the groups. Compared with the Private/HMO group, all three groups had higher generalized estimating equation-adjusted mortality (OR, 1.15; 95% CI, 1.08-1.21; P < .001; OR, 1.18; 95% CI, 1.09-1.29; P < .001 and OR, 1.13; 95% CI, 1.01-1.25; P = .026), for Medicare, Medicaid, and NID, respectively. After propensity matching, mortality for Medicare was similar (P = .1197) and higher for NID (P = .0015) and Medicaid (P = .0015) groups. Conclusions: These findings suggest that among centers participating in a national quality improvement initiative patient insurance status may be associated with differences in cardiovascular care and outcomes.
AB - Background: Prior studies have documented that patients' health insurance status can impact use of guideline-based care as well as acute outcomes for coronary artery disease. Whether insurance status remains a contemporary influence among centers participating in a national quality improvement initiative is unknown. Methods: We analyzed data from 237,779 admissions with coronary artery disease from 527 hospitals participating in the Get With The Guidelines-Coronary Artery Disease Program from 2000 to 2008. Insurance status was Medicare (48.8%), Private/Health Maintenance Organization (HMO) (34.9%), Medicaid (8.2%), and No Insurance Documented (NID) (8.2%). Quality of care was measured using standard quality indicators covering acute treatment and discharge measures, utilization of invasive procedures, length of stay, and mortality. Relationship between different insurance types was examined using generalized estimating equation logistic regression and propensity-score matching adjusting for demographics, comorbidities and hospital characteristics. Results: After propensity matching, full compliance with all eligible measures (deficit-free care) relative to Private/HMO was lower for Medicare (P < .0001) and Medicaid (P < .0001) and higher for the NID group (P = .0312). The acute reperfusion times were comparable among the groups. Compared with the Private/HMO group, all three groups had higher generalized estimating equation-adjusted mortality (OR, 1.15; 95% CI, 1.08-1.21; P < .001; OR, 1.18; 95% CI, 1.09-1.29; P < .001 and OR, 1.13; 95% CI, 1.01-1.25; P = .026), for Medicare, Medicaid, and NID, respectively. After propensity matching, mortality for Medicare was similar (P = .1197) and higher for NID (P = .0015) and Medicaid (P = .0015) groups. Conclusions: These findings suggest that among centers participating in a national quality improvement initiative patient insurance status may be associated with differences in cardiovascular care and outcomes.
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U2 - 10.1016/j.ahj.2010.03.013
DO - 10.1016/j.ahj.2010.03.013
M3 - Article
C2 - 20569716
AN - SCOPUS:77952984909
SN - 0002-8703
VL - 159
SP - 1026
EP - 1036
JO - American heart journal
JF - American heart journal
IS - 6
ER -