Differences in Patient-Reported Processes and Outcomes Between Men and Women with Myocardial Infarction

Authors

  • Kenneth E. Covinsky MD, MPH,

    1. Division of Geriatrics, University of California, San Francisco School of Medicine, and the San Francisco VA Medical Center, San Francisco, Calif
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  • Mary-Margaret Chren MD,

    1. Department of Dermatology, University of California, San Francisco School of Medicine, and the San Francisco VA Medical Center, San Francisco, Calif
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  • Dwain L. Harper DO,

    1. The Quality Information Management Corporation and Cleveland Health Quality Choice, Cleveland, Ohio
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  • Lynne E. Way MBA,

    1. The Quality Information Management Corporation and Cleveland Health Quality Choice, Cleveland, Ohio
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  • Gary E. Rosenthal MD

    1. The Division of General Internal Medicine, University of Iowa College of Medicine and the Iowa City VA Medical Center, Iowa City, Iowa
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Address correspondence and reprint requests to Dr. Covinsky: San Francisco VA Medical Center (111G), 4150 Clement St., Bldg. 1, San Francisco, CA 94121 (e-mail: covinsky@medicine.ucsf.edu).

Abstract

OBJECTIVE: Previous research measuring differences in the care between men and women with myocardial infarction has focused on differences in procedure use and mortality. However, little is known about differences in processes and outcomes that are reported by patients, such as interpersonal processes of care and health status. Our goal was to measure differences in patient-reported measures for men and women who recently were hospitalized with myocardial infarction.

PARTICIPANTS AND SETTING: We surveyed by mail patients with myocardial infarction discharged to home from one of 27 Cleveland area hospitals 3 months following discharge; 502 (64%) of 783 patients responded. The mean age of subjects was 65 years and 40% were women.

MEASUREMENTS: Process measures included the quality of communication during the hospitalization and at time of discharge and reports of health education discussions during hospitalization. Outcome measures included physical and mental health component scores of the Medical Outcomes Study 36-Item Short-Form Health Survey, change in work status, and days spent in bed because of ill health. We compared processes and outcomes in men and women using multivariate analyses that adjusted for age, other demographic characteristics, comorbid conditions, severity of the myocardial infarction, and premorbid global health status.

MAIN RESULTS: In multivariate analyses, women were as likely as men to report at least one problem with communication during the hospitalization (odds ratio [OR] 0.86; 95% confidence interval [95% CI] 0.56 to 1.33) or at time of discharge (OR 1.24; 95% CI, 0.82 to 1.89) and to report that they were given dietary advice before discharge (OR 0.60; 95% CI, 0.36 to 1.01), were told what to do if they developed chest pain (OR 1.21; 95% CI, 0.66 to 2.23), or, if they smoked cigarettes, given advice about how to stop smoking (OR 0.64; 95% CI, 0.26 to 1.58). However, 3 months after discharge, women reported worse physical health (P < .05) and mental health (P < .05), were more likely to report spending time in bed because of ill health (OR 1.80; 95% CI, 1.06, 3.05), and were more likely to report working less than before their myocardial infarction (OR 4.02; 95% CI, 1.58 to 10.20).

CONCLUSIONS: In terms of processes of care measured with patient reports, women with myocardial infarction reported their quality of care to be similar to that of men. However, 3 months following myocardial infarction, women reported worse health status and were less likely to return to work than men.

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