Admission to hospitals with on-site cardiac catheterization facilities : Impact on long-term costs and outcomes.
Background-Admission to a hospital with a capability for cardiac procedures is associated with a higher likelihood of referral for a cardiac procedure but not with a better short-term clinical outcome.
Whether there are differences in long-term mortality and resource consumption is not clear.
We sought to determine whether elderly Medicare patients with acute myocardial infarction admitted to hospitals with on-site cardiac catheterization facilities have lower long-term hospital costs and better outcomes than patients admitted to hospitals without such facilities.
Methods and Results-As part of the Cooperative Cardiovascular Project pilot in Connecticut, we conducted a retrospective cohort study using data from medical charts and administrative files.
The study sample included 2521 patients with acute myocardial infarction covered by Medicare from 1992 to 1993.
The cardiac catheterization rate was higher in the hospitals with facilities (38.6% versus 26.9% ; P<0.001), but the revascularization rate was similar (20.5% versus 19.5%) during the initial episode of care and at 3 years (29.7% versus 29.7%). Mortality rates were similar for patients admitted to the 2 types of hospitals at 30 days (OR, 1.08 ; 95% CI, 0.83 to 1.42) and at 3 years (OR, 1.02 ; 95% CI, 0.83 to 1.26).
The adjusted readmission rates were significantly lower among patients admitted to hospitals with cardiac catheterization facilities (OR, 0.76 ; 95% CI, 0.61 to 0.94). (...)
Mots-clés Pascal : Infarctus, Myocarde, Aigu, Hôpital, Cathétérisme, Analyse coût, Economie santé, Pronostic, Homme, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie
Mots-clés Pascal anglais : Infarct, Myocardium, Acute, Hospital, Catheterization, Cost analysis, Health economy, Prognosis, Human, Cardiovascular disease, Coronary heart disease, Myocardial disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0005038
Code Inist : 002B12A03. Création : 31/05/1999.