Insurance status and the treatment of myocardial infarction at academic centers.
Publication/Presentation Date
4-1-2004
Abstract
UNLABELLED: Numerous studies have documented treatment disparities in patients with acute coronary syndromes based on race and gender. Other causes for treatment disparities may exist.
OBJECTIVES: To determine if insurance status affects quality of care in patients with acute myocardial infarction (AMI) presenting to academic health centers.
METHODS: The Internet Tracking Registry for Acute Coronary Syndromes (i*trACS), a prospective multicenter registry of patients with chest pain presenting to the emergency department who receive an electrocardiogram, was used as the database (N = 17,737). A subset of patients who were diagnosed as having AMI were selected from the database (n = 936). Patients were classified as having either ST-segment elevation MI (n = 178) or non-ST-segment elevation MI (n = 758). Insurance status, age, race, and gender were extracted as predictor variables. The influence of predictor variables on treatment modality was investigated using logistic regression, adjusted for clustering within sites.
RESULTS: The odds of a self-pay patient with ST-segment elevation MI receiving fibrinolytics were 3.23 (95% CI = 1.56 to 6.69) times higher than for other patients. Patients with Medicare coverage were less likely to receive fibrinolytics (odds ratio [OR] 0.35, 95% CI = 0.19 to 0.65) and tended to undergo percutaneous coronary intervention less often (OR 0.60, 95% CI = 0.36 to 1.01). The odds of a privately insured patient's receiving coronary artery bypass grafting (OR 2.76, 95% CI = 1.62 to 4.72) or percutaneous coronary intervention (OR 1.47, 95% CI = 1.03 to 2.11) were higher than for other patients.
CONCLUSIONS: Insurance coverage appears to affect treatment in patients with AMI, with self-pay patients more likely to receive less-expensive therapies and insured patients more likely to receive invasive treatments.
Volume
11
Issue
4
First Page
343
Last Page
348
ISSN
1069-6563
Published In/Presented At
Hiestand, B. C., Prall, D. M., Lindsell, C. J., Hoekstra, J. W., Pollack, C. V., Hollander, J. E., Tiffany, B. R., Peacock, W. F., Diercks, D. B., & Gibler, W. B. (2004). Insurance status and the treatment of myocardial infarction at academic centers. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 11(4), 343–348. https://doi.org/10.1197/j.aem.2003.12.017
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
15064206
Department(s)
Administration and Leadership
Document Type
Article