American Heart Journal
Volume 146, Issue 2 , Pages 242-249 , August 2003

Regional variation in the treatment and outcomes of myocardial infarction: investigating New England’s advantage

  • Harlan M Krumholz, MD

      Affiliations

    • Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn, USA
    • Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn, USA
    • Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Conn, USA
    • Qualidigm, Middletown, Conn, USA
    • Corresponding Author InformationReprint requests: Harlan M. Krumholz, MD, Yale University School of Medicine, 333 Cedar St, PO Box 208088, New Haven, CT 06520-8088, USA.
  • ,
  • Jersey Chen, MD, MPH

      Affiliations

    • Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn, USA
  • ,
  • Saif S Rathore, MPH

      Affiliations

    • Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn, USA
  • ,
  • Yun Wang, MS

      Affiliations

    • Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Conn, USA
    • Qualidigm, Middletown, Conn, USA
  • ,
  • Martha J Radford, MD

      Affiliations

    • Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn, USA
    • Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Conn, USA
    • Yale-New Haven Health Center for Outcomes Research and Evaluation, New Haven, Conn, USA

Received 20 March 2002 ,Accepted 30 October 2002.

References 

  1. Pilote L, Califf RM, Sapp S, et al.  Regional variation across the United States in the management of acute myocardial infarction. N Engl J Med. 1995;333:565–572
  2. Krumholz HM, Radford MJ, Wang Y, et al.  National use and effectiveness of beta-blockers for the treatment of elderly patients after acute myocardial infarction (national Cooperative Cardiovascular Project). JAMA. 1998;280:623–629
  3. O’Connor GT, Quinton HB, Traven ND, et al.  Geographic variation in the treatment of acute myocardial infarction (the Cooperative Cardiovascular Project). JAMA. 1999;281:627–633
  4. Gunnar RM, Passamani ER, Bourdillon PD, et al.  Guidelines for the early management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee to Develop Guidelines for the Early Management of Patients with Acute Myocardial Infarction). J Am Coll Cardiol. 1990;16:249–292
  5. Ryan TJ, Anderson JL, Antman EM, et al.  ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol. 1996;28:1328–1428
  6. Jencks SF, Wilensky GR. The health care quality improvement initiative (a new approach to quality assurance in Medicare). JAMA. 1992;268:900–903
  7. Jollis JG, Ancukiewicz M, DeLong ER, et al.  Discordance of databases designed for claims payment versus clinical information systems. Ann Intern Med. 1993;119:844–850
  8. Bureau of the Census . State and metropolitan area data book, 1991. Washington, DC: US Government Printing Office; 1991;
  9. Krieger N. Overcoming the absence of socioeconomic data in medical records (validation and application of a census-based methodology). Am J Public Health. 1992;82:703–710
  10. Marciniak TA, Ellerbeck EF, Radford MJ, et al.  Improving the quality of care for Medicare patients with acute myocardial infarction (results from the Cooperative Cardiovascular Project). JAMA. 1998;279:1351–1357
  11. Krumholz HM, Radford MJ, Wang Y, et al.  Early beta-blocker therapy for acute myocardial infarction in elderly patients. Ann Intern Med. 1999;131:648–654
  12. Zhang J, Yu KF. What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280:1690–1691
  13. Jencks SF, Cuerdon T, Burwen DR, et al.  Quality of medical care delivered to Medicare beneficiaries (a profile at state and national levels). JAMA. 2000;284:1670–1676
  14. Rathore SS, Berger AK, Weinfurt KP, et al.  Race, sex, poverty and the medical treatment of acute myocardial infarction in the elderly. Circulation. 2000;102:642–648
  15. Ayanian JZ, Guadagnoli E, McNeil BJ, et al.  Treatment and outcomes of acute myocardial infarction among patients of cardiologists and generalist physicians. Arch Intern Med. 1997;157:2570–2576
  16. Jollis JG, DeLong ER, Peterson ED, et al.  Outcome of acute myocardial infarction according to the specialty of the attending physician. N Engl J Med. 1996;335:1880–1887
  17. Frances CD, Go AS, Dauterman KW, et al.  Outcome following acute myocardial infarction (are differences among physician specialties the result of quality of care or case mix?). Arch Intern Med. 1999;159:1429–1436
  18. Chen J, Radford MJ, Wang Y, et al.  Care and outcomes of elderly patients with acute myocardial infarction by physician specialty (the effects of comorbidity and functional limitations). Am J Med. 2000;108:460–469
  19. Allison JJ, Kiefe CI, Weissman NW, et al.  Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI. JAMA. 2000;284:1256–1262
  20. Taylor DH, Whellan DJ, Sloan FA. Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries. N Engl J Med. 1999;340:293–299
  21. Yuan Z, Cooper GS, Einstader D, et al.  The association between hospital type and mortality and length of stay (a study of 16.9 million hospitalized Medicare beneficiaries). Med Care. 2000;38:231–245
  22. Thiemann DR, Coresh J, Oetgen WJ, et al.  The association between hospital volume and survival after acute myocardial infarction in elderly patients. N Engl J Med. 1999;340:1640–1648
  23. Brass LM, Lichtman JH, Wang Y, et al.  Intracranial hemorrhage associated with thrombolytic therapy for elderly patients with acute myocardial infarction (results from the Cooperative Cardiovascular Project). Stroke. 2000;31:1802–1811
  24. Berger AK, Radford MJ, Wang Y, et al.  Thrombolytic therapy in older patients. J Am Coll Cardiol. 2000;36:366–374
  25. Thiemann DR, Coresh J, Schulman SP, et al.  Lack of benefit for intravenous thrombolysis in patients with myocardial infarction who are older than 75 years. Circulation. 2000;101:2239–2246
  26. Guadagnoli E, Hauptman PJ, Ayanian JZ, et al.  Variation in the use of cardiac procedures after acute myocardial infarction. N Engl J Med. 1995;333:573–578
  27. Tu JV, Pashos CL, Naylor CD, et al.  Use of cardiac procedures and outcomes in elderly patients with myocardial infarction in the United States and Canada. N Engl J Med. 1997;336:1500–1505

 Dr Chen is currently affiliated with the Department of Medicine, Beth-Israel Hospital, Boston, Mass.Analyses performed under Contract Number 500-99-CT01, “Utilization and Quality Control Peer Review Organization for the State of Connecticut,” sponsored by the Centers for Medicare & Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare & Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this Contractor.

PII: S0002-8703(03)00237-0

doi: 10.1016/S0002-8703(03)00237-0

American Heart Journal
Volume 146, Issue 2 , Pages 242-249 , August 2003