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Under use of coronary angiography: application of a clinical method
M Laouri1, R L Kravitz, S J Bernstein
1Department of Health Services, UCLA, USA. laouri_ma@al.phs.com
Insights
Under use of necessary coronary angiography is significant, with women and public hospital patients receiving it less often. Developing quality standards is crucial to ensure equitable access to essential cardiac care.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Medical Quality Assurance
Background:
- Coronary angiography is a critical diagnostic tool for assessing coronary artery disease.
- Underutilization of necessary medical procedures can lead to suboptimal patient outcomes.
- Disparities in healthcare access and utilization exist among different patient demographics and healthcare settings.
Purpose of the Study:
- To quantify the underuse of coronary angiography in patients with positive exercise stress tests.
- To investigate potential disparities in receiving necessary coronary angiography based on sex, ethnicity, socioeconomic status, and insurance coverage.
- To compare the utilization of coronary angiography between public and private hospitals.
Main Methods:
- Retrospective cohort study involving chart review and patient interviews at four Los Angeles teaching hospitals.
- Inclusion of 352 patients with positive exercise stress tests meeting criteria for necessary coronary angiography.
- Logistic regression analysis to adjust for demographic and clinical characteristics and estimate odds ratios for receiving angiography within 3 and 12 months.
Main Results:
- Only 43% of patients received necessary coronary angiography within 3 months and 56% within 12 months.
- Women were significantly less likely than men to undergo necessary coronary angiography (AOR 0.47-0.54).
- Patients in public hospitals received necessary coronary angiography less frequently than those in private hospitals (AOR 0.40-0.52).
Conclusions:
- Significant underuse of coronary angiography was identified, indicating a need for quality improvement.
- Disparities in access to necessary cardiac procedures were observed, particularly for women and public hospital patients.
- Establishing quality standards is essential to prevent underuse and ensure equitable delivery of necessary medical care.
Objective:
To estimate the extent of under use of coronary angiography and to determine whether women, ethnic minorities and poor and uninsured patients are less likely than their counterparts to receive necessary coronary angiography.
Design:
Retrospective cohort study employing chart review and patient interviews.
Setting:
Four teaching hospitals: three government owned (public) and one private university medical center in Los Angeles, California.
Patients:
Three hundred and fifty two patients who had a positive exercise stress test between 1 January 1990 and 30 June 1991 and met explicitly defined criteria for the necessity of coronary angiography established by a multidisciplinary expert panel.
Main Outcome Measures:
Percentage of patients who received necessary coronary angiography within 3 and 12 months following exercise stress testing, adjusted for demographic and clinical characteristics using logistic regression.
Results:
Overall 43% received necessary coronary angiography within 3 months and 56% within 12 months of the stress test. Women were less likely than men to receive necessary coronary angiography. Adjusted odds ratio (AOR) 0.54, 95% confidence interval (CI) 0.34-0.90 for angiography within 3 months of the stress test; AOR 0.47, 95% CI 0.29-0.77 for angiography within 12 months of the stress test. Public hospital patients underwent necessary coronary angiography less often than private hospital patients. AOR 0.40, 95% CI 0.23-0.79 for within 3 months; AOR 0.52, 95% CI 0.30-0.91 for within 12 months.
Conclusions:
Under use of coronary angiography can be measured and occurs to a significant degree. It is important to develop standards of quality to address and safeguard against under use of necessary medical care.
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