The association between the on-site availability of cardiac procedures and the utilization of those services for acute myocardial infarction by payer group

John G. Canto, William J. Rogers, Yuan Zhang, Jeffrey M. Roseman, William J. French, Joel M. Gore, Nisha Chandra

Research output: Contribution to journalArticle

Abstract

Background: Prior studies have suggested that in-hospital availability may be an important determinant for the use of invasive cardiac services; however, whether this association is influenced by payer status remains unclear. Hypothesis: The interaction of payer status and the on-site availability of coronary arteriography is associated with increased utilization of this procedure. Methods: In-hospital availability and utilization of coronary arteriography was ascertained in 275,046 patients with acute myocardial infarction (AMI) enrolled in the National Registry of Myocardial Infarction 2 from June 1994 to April 1996. Logistic regression analyses were performed to determine the association between the on-site availability of cardiac catheterization at the initial hospital and subsequent utilization of coronary arteriography. Similar analyses were performed within Medicare, Medicaid, Commercial, Health Maintenance Organization (HMO), and Uninsured payer groups. Results: Patients initially admitted to hospitals having on-site cardiac catheterization facilities were almost twice as likely to receive coronary arteriography as patients admitted to hospitals without such facilities and later transferred out [un-adjusted odds ratio (OR) = 1.69, 95% confidence interval (CI) 1.66-1.73, p <0.0001; adjusted OR = 2.08, 95% CI 2.01-2.15, p <0.0001]. Furthermore, this relationship of increased utilization with greater availability was evident within each payer group, but was highest among those with Commercial insurance and lowest among Medicaid recipients: [Commercial insurance (OR = 2.19, 95% CI 2.07-2.31, p <0.0001); Uninsured (OR = 1.74, 95% CI 1.57-1.92, p <0.0001); HMO (OR = 1.67, 95% CI 1.54-1.82, p

Original languageEnglish (US)
Pages (from-to)519-524
Number of pages6
JournalClinical Cardiology
Volume22
Issue number8
StatePublished - 1999

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Odds Ratio
Myocardial Infarction
Confidence Intervals
Angiography
Health Maintenance Organizations
Medicaid
Cardiac Catheterization
Insurance
Medicare
Registries
Logistic Models
Regression Analysis

Keywords

  • Acute myocardial infarction
  • Coronary arteriography
  • Health insurance
  • Payer status

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The association between the on-site availability of cardiac procedures and the utilization of those services for acute myocardial infarction by payer group. / Canto, John G.; Rogers, William J.; Zhang, Yuan; Roseman, Jeffrey M.; French, William J.; Gore, Joel M.; Chandra, Nisha.

In: Clinical Cardiology, Vol. 22, No. 8, 1999, p. 519-524.

Research output: Contribution to journalArticle

Canto, John G. ; Rogers, William J. ; Zhang, Yuan ; Roseman, Jeffrey M. ; French, William J. ; Gore, Joel M. ; Chandra, Nisha. / The association between the on-site availability of cardiac procedures and the utilization of those services for acute myocardial infarction by payer group. In: Clinical Cardiology. 1999 ; Vol. 22, No. 8. pp. 519-524.
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abstract = "Background: Prior studies have suggested that in-hospital availability may be an important determinant for the use of invasive cardiac services; however, whether this association is influenced by payer status remains unclear. Hypothesis: The interaction of payer status and the on-site availability of coronary arteriography is associated with increased utilization of this procedure. Methods: In-hospital availability and utilization of coronary arteriography was ascertained in 275,046 patients with acute myocardial infarction (AMI) enrolled in the National Registry of Myocardial Infarction 2 from June 1994 to April 1996. Logistic regression analyses were performed to determine the association between the on-site availability of cardiac catheterization at the initial hospital and subsequent utilization of coronary arteriography. Similar analyses were performed within Medicare, Medicaid, Commercial, Health Maintenance Organization (HMO), and Uninsured payer groups. Results: Patients initially admitted to hospitals having on-site cardiac catheterization facilities were almost twice as likely to receive coronary arteriography as patients admitted to hospitals without such facilities and later transferred out [un-adjusted odds ratio (OR) = 1.69, 95{\%} confidence interval (CI) 1.66-1.73, p <0.0001; adjusted OR = 2.08, 95{\%} CI 2.01-2.15, p <0.0001]. Furthermore, this relationship of increased utilization with greater availability was evident within each payer group, but was highest among those with Commercial insurance and lowest among Medicaid recipients: [Commercial insurance (OR = 2.19, 95{\%} CI 2.07-2.31, p <0.0001); Uninsured (OR = 1.74, 95{\%} CI 1.57-1.92, p <0.0001); HMO (OR = 1.67, 95{\%} CI 1.54-1.82, p",
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AU - Rogers, William J.

AU - Zhang, Yuan

AU - Roseman, Jeffrey M.

AU - French, William J.

AU - Gore, Joel M.

AU - Chandra, Nisha

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N2 - Background: Prior studies have suggested that in-hospital availability may be an important determinant for the use of invasive cardiac services; however, whether this association is influenced by payer status remains unclear. Hypothesis: The interaction of payer status and the on-site availability of coronary arteriography is associated with increased utilization of this procedure. Methods: In-hospital availability and utilization of coronary arteriography was ascertained in 275,046 patients with acute myocardial infarction (AMI) enrolled in the National Registry of Myocardial Infarction 2 from June 1994 to April 1996. Logistic regression analyses were performed to determine the association between the on-site availability of cardiac catheterization at the initial hospital and subsequent utilization of coronary arteriography. Similar analyses were performed within Medicare, Medicaid, Commercial, Health Maintenance Organization (HMO), and Uninsured payer groups. Results: Patients initially admitted to hospitals having on-site cardiac catheterization facilities were almost twice as likely to receive coronary arteriography as patients admitted to hospitals without such facilities and later transferred out [un-adjusted odds ratio (OR) = 1.69, 95% confidence interval (CI) 1.66-1.73, p <0.0001; adjusted OR = 2.08, 95% CI 2.01-2.15, p <0.0001]. Furthermore, this relationship of increased utilization with greater availability was evident within each payer group, but was highest among those with Commercial insurance and lowest among Medicaid recipients: [Commercial insurance (OR = 2.19, 95% CI 2.07-2.31, p <0.0001); Uninsured (OR = 1.74, 95% CI 1.57-1.92, p <0.0001); HMO (OR = 1.67, 95% CI 1.54-1.82, p

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KW - Coronary arteriography

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KW - Payer status

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