Disclosure statement: Dr. Sharma reported that he has a research grant from Boston Scientific, Inc., and serve on speaker's bureau of Boston Scientific, Inc., Abbott Vasclar, Lilly, and the Medicine Co., Dr. King reported that he receives equity from Celonova Biosciences, Inc., and serves as a board member for Merck & Company, Wyeth Pharmaceuticals, Contact Surgical, and Medtronic & Co.
Underutilization of Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction in Medicaid Patients Relative to Private Insurance Patients
Article first published online: 20 AUG 2013
© 2013, Wiley Periodicals, Inc.
Journal of Interventional Cardiology
Volume 26, Issue 5, pages 470–481, October 2013
How to Cite
HANNAN, E. L., ZHONG, Y., WALFORD, G., JACOBS, A. K., VENDITTI, F. J., STAMATO, N. J., HOLMES, D. R., SHARMA, S., GESTEN, F. and KING, S. B. (2013), Underutilization of Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction in Medicaid Patients Relative to Private Insurance Patients. Journal of Interventional Cardiology, 26: 470–481. doi: 10.1111/joic.12059
- Issue published online: 8 OCT 2013
- Article first published online: 20 AUG 2013
- New York State Department of Health (OHSM: 1101681-1-60687/OHIP: 1103146-1-61339)
To determine whether disparities in access to invasive cardiac procedures still exist for Medicaid patients, given how old earlier studies are and given changes in the interim in appropriateness guidelines.
Patients and Methods
A total of 5,022 Medicaid and private insurance patients in New York from January 1, 2008 through December 31, 2009 under age 65 with ST-elevation myocardial infarction (STEMI) were compared with regard to their access to percutaneous coronary interventions (PCI) before and after controlling for numerous patient characteristics and other important factors.
Medicaid patients were significantly less likely to be admitted initially to a hospital certified to perform PCI (90.4% vs. 94.3%, P < 0.001). Also, Medicaid patients were found to be significantly less likely to undergo PCI than other patients (adjusted odds ratio [AOR] = 0.81, 95% CI 0.66, 0.98, P = 0.03). When the probability of each hospital performing PCI for STEMI patients was controlled for, Medicaid patients were still less likely to undergo PCI after controlling for other risk factors (AOR = 0.80, 95% CI 0.65, 0.99, P = 0.04).
Medicaid STEMI patients are significantly less likely to undergo PCI within the same day of admission as private pay patients even after adjusting for patient characteristics related to receiving PCI, and the strength of this relationship is not diminished when controlling for whether the admitting hospital has approval to perform PCI or controlling for the tendency of the admitting hospital to treat STEMI with PCI. (J Interven Cardiol 2013;26:470-481)