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Sequential events contributing to variations in cardiac revascularization rates
J Blustein1, R R Arons, S Shea
1Division of General Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Insights
Racial and insurance disparities affect cardiac revascularization treatment at multiple care stages. Patients with private insurance had higher probabilities for receiving bypass surgery or angioplasty compared to uninsured individuals.
Area of Science:
- Health Services Research
- Cardiovascular Medicine
- Health Disparities
Background:
- Existing research highlights race, payor, and gender influences on cardiac service utilization.
- Less is known about specific care process points where utilization differences emerge.
Purpose of the Study:
- To investigate the sequence of care phases influencing revascularization procedure use.
- To identify disparities in treatment probabilities across different racial and payor groups.
Main Methods:
- Analysis of a cohort of 5857 patients hospitalized with acute myocardial infarction in California in 1991.
- Examination of four care phases: prehospital, intrahospital, interhospital, and posthospital.
Main Results:
- Significant differences in treatment probabilities were observed across racial and payor groups in nearly all care phases.
- Patients with private insurance showed higher likelihoods of initial hospital admission for revascularization, undergoing the procedure, transfer for revascularization, and readmission for revascularization compared to uninsured patients.
Conclusions:
- Discrepancies in cardiac revascularization service use are cumulative effects of differential care processes across multiple phases.
- Addressing these phase-specific disparities is crucial for improving equitable access to cardiac procedures.
Abstract:
Numerous studies have demonstrated the importance of race, payor, and gender in determining the use of cardiac services, including revascularization procedures (bypass surgery and angioplasty). However, there has been less investigation into where and when in the process of care differences in utilization arise. In this report, the authors examined the sequence of events leading to the use of revascularization procedures, identifying four phases of care (prehospital, intrahospital, interhospital, and posthospital). Following a cohort of 5857 patients admitted to California hospitals with acute myocardial infarction in 1991, the authors found differences in treatment probabilities during nearly every phase for different racial and payor groups. For example, compared with patients who are uninsured, patients with private insurance were more likely to be admitted initially to a hospital offering revascularization (adjusted odds ratio [OR] = 1.40, 95% confidence interval [CI] 1.30 to 1.51). Moreover, once admitted to such a hospital, private patients were more likely to undergo revascularization (adjusted OR = 2.30; 95% CI 1.80 to 2.94). They were also more likely to undergo transfer to receive revascularization (adjusted OR = 1.22; 95% CI 1.03 to 1.45), and to be readmitted for revascularization (adjusted OR = 1.60; 95% CI 1.13 to 2.27). Previously reported discrepancies in service use represent the cumulative effects of multiple phases during which different racial and payor groups experience different processes of care.