A previous study of health care utilization by Medicare beneficiaries in Kansas showed significant urban-rural differences. To test the hypothesis that these differences may be explained by similar differences in the quality of care provided by hospitals; urban, semi-rural and rural hospitals in Kansas were compared in terms of the quality of inpatient care provided for the elderly with acute myocardial infarction (AMI). Clinical data abstracted from hospital medical records for HCFA’s Cooperative Cardiovascular Project (CCP) were analyzed. The study population was a 100% sample of Medicare patients (n=2,521) who survived AMI and were discharged from hospitals during an 8-month period in 1994-95. The CCP quality indicators (QIs)in this study were the use of aspirin during hospital stay and at discharge, beta-blockers, IV nitroglycerin, heparin, and reperfusion by thrombolytic therapy or angioplasty. A significantly higher proportion of ideal candidates for aspirin during hospital stay and at discharge, heparin, and IV nitroglycerin received these medications in urban hospitals, and a lower proportion of similar patients received these medications in rural hospitals as compared to the patients in semi-rural hospitals (p<0.001). Similar trends in each of the six QIs were seen for non-ideal patients (p<0.05). Age adjustments did not change the observed urban-rural differences in all QI measures except for the administration of IV nitroglycerine. A consistent pattern of relatively poor quality of care for AMI provided by rural hospitals was observed. There is greater opportunity for improvements in the rural hospitals.
Learning Objectives: This paper will demonstrate disparity in the quality of medical care provided to the elderly. It will generate interest in exploring other clincal processes and health care provider characteristics which are associated with poor quality of medical care
Keywords: Myocardial Infarction, Quality of Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.