Acute Myocardial Infarction and Coronary Artery Bypass Grafting Outcomes in Specialty and General Hospitals: Analysis of State Inpatient Data

Authors

  • Peter Cram,

    1. Division of General Medicine, University of Iowa Carver College of Medicine, Iowa City VA Medical Center, Mail Stop 152, Iowa City, IA
    2. Center for Research in the Implementation of Innovative Strategies for Practice (CRIISP), Iowa City Veterans Administration Medical Center, Iowa City, IA
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    • Address correspondence to Peter Cram, M.D., M.B.A., Division of General Medicine, University of Iowa Carver College of Medicine, Iowa City VA Medical Center, Mail Stop 152, Iowa City, IA; e-mail: peter-cram@uiowa.edu. Peter Cram is also with the Center for Research in the Implementation of Innovative Strategies for Practice (CRIISP), Iowa City Veterans Administration Medical Center, Iowa City, IA. Levent Bayman, M.S., Joanna Popescu, M.D., M.P.H., and Mary S. Vaughan-Sarrazin, Ph.D., are with the Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA. Mary S. Vaughan-Sarrazin, Ph.D., is also with the Center for Research in the Implementation of Innovative Strategies for Practice, Iowa City VA Medical Center, Iowa City, IA.

  • Levent Bayman,

    1. Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
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  • Joanna Popescu,

    1. Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
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  • Mary S. Vaughan-Sarrazin

    1. Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
    2. Center for Research in the Implementation of Innovative Strategies for Practice, Iowa City VA Medical Center, Iowa City, IA.
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Abstract

Objective. Compare characteristics and outcomes of patients hospitalized in specialty cardiac and general hospitals for acute myocardial infarction (AMI) and coronary artery bypass grafting (CABG).

Data. 2000–2005 all-payor administrative data from Arizona, California, Texas, and Wisconsin.

Study Design. We identified patients admitted to specialty and competing general hospitals with AMI or CABG and compared patient demographics, comorbidity, and risk-standardized mortality in specialty and general hospitals.

Principal Findings. Specialty hospitals admitted a lower proportion of women and blacks and treated patients with less comorbid illness than general hospitals. Unadjusted in-hospital AMI mortality for Medicare enrollees in specialty and general hospitals was 6.1 and 10.1 percent (p<.0001) and for non-Medicare enrollees was 2.8 and 4.0 percent (p<.04). Unadjusted in-hospital CABG mortality for Medicare enrollees in specialty and general hospitals was 3.2 and 4.7 percent (p<.01) and for non-Medicare enrollees was 1.1 and 1.8 percent (p=.02). After adjusting for patient characteristics and hospital volume, risk-standardized in-hospital mortality for all AMI patients was 2.7 percent for specialty hospitals and 4.1 percent for general hospitals (p<.001) and for CABG was 1.5 percent for specialty hospitals and 2.0 percent for general hospitals (p=.07).

Conclusions. In-hospital mortality in specialty hospitals was lower than in general hospitals for AMI but similar for CABG. Our results suggest that specialty hospitals may offer significantly better outcomes for AMI but not CABG.

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