Clinical InvestigationCoronary Artery DiseaseAssociation of insurance status with inpatient treatment for coronary artery disease: Findings from the Get With the Guidelines program
Section snippets
Data collection
The GWTG-CAD quality initiative is a hospital-based program that relies on a multidisciplinary team consisting of nurses, physicians, quality improvement staff, administrative leaders and other allied health professionals as previously described.10 It includes didactic sessions, best practice sharing, interactive workshops, and a Web-based patient management tool (Outcome Sciences Inc, Cambridge, Massachusetts).11 This patient management tool provides concurrent data collection, clinical
Patient characteristics
Of all admissions for CAD (n = 237,779), insurance status was Medicare (48.8%), Private/Health Maintenance Organization (HMO) (34.9%), Medicaid (8.2%), and No Insurance Documented (NID) (8.2%). Baseline characteristics for the 4 groups are listed in Table I. Medicare patients were older than the other groups while patients with Private/HMO and NID insurance status were younger and >70% male. Medicaid patients were more likely black or Hispanic. The differences among the groups in blood
Discussion
Despite major advances in the last 2 decades in prevention and treatment of CAD and MI, access to evidence-based care in the United States may be limited by patients' insurance status. Lack of insurance may influence access to and delivery of care in both the inpatient and outpatient environment. Insurance status may bias health care providers and prevent patients from receiving appropriate care.14 Our results indicate that among GWTG-CAD participating hospitals patients with Medicare and
Disclosures
MIV: Honoraria — Eli Lilly, Daiichi Sankyo, Medicure <$10,000
SV: none
CPC: Research Grant—Accumetrics, AstraZeneca, Bristol-Myers Squibb/Sanofi Partnership, Glaxo Smith Kline, Merck, Merck/Schering Plough Partnership >$10,000; Expert Witness—one case in Virginia >$10,000, one ongoing case in Michigan <$10,000; Ownership Interest—Automedics Medical Systems <$10,000, Consultant/Advisory Board—Automedics <$10,000; Other disclosures—Senior Investigator, TIMI Study Group, $ = N/A
EDP: Research
References (28)
- et al.
Poverty, process of care, and outcome in acute coronary syndromes
J Am Coll Cardiol
(2003) - et al.
Relation of insurance status to performance of coronary angiography in patients with unstable angina pectoris or acute myocardial infarction
Am J Cardiol
(2003) - et al.
Influence of insurance type on the use of procedures, medications and hospital outcome in patients with unstable angina: results from the GUARANTEE Registry. Global Unstable Angina Registry and Treatment Evaluation.
J Am Coll Cardiol
(1998) - et al.
Guideline-Based Standardized Care Is Associated With Substantially Lower Mortality in Medicare Patients With Acute Myocardial Infarction: The American College of Cardiology's Guidelines Applied in Practice (GAP) Projects in Michigan
J Am Coll Cardiol
(2005) - et al.
Using “get with the guidelines” to improve cardiovascular secondary prevention
Jt Comm J Qual Saf
(2003) - et al.
A comparison of acute coronary syndrome care at academic and nonacademic hospitals
Am J Med
(2007) - et al.
Weekend/holiday versus weekday hospital discharge and guideline adherence (from the American Heart Association's Get with the Guidelines–Coronary Artery Disease database)
Am J Cardiol
(2008) - et al.
AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute.
J Am Coll Cardiol
(2006) - et al.
Insurance coverage and care of patients with non-ST-segment elevation acute coronary syndromes
Ann Intern Med
(2006)
Payer status and the utilization of hospital resources in acute myocardial infarction: a report from the National Registry of Myocardial Infarction 2
Arch Intern Med
Underuse of invasive procedures among Medicaid patients with acute myocardial infarction
Am J Public Health
An Organized Approach to Improvement in Guideline Adherence for Acute Myocardial Infarction: results with the Get With The Guidelines Quality Improvement Program
Arch Intern Med
Get with the guidelines for cardiovascular secondary prevention: pilot results
Arch Intern Med
Cited by (17)
Disparities in the management of non-ST-segment elevation myocardial infarction in the United States
2023, International Journal of CardiologyGlobal geographical variation in patient characteristics in percutaneous coronary intervention clinical trials: A systematic review and meta-analysis
2018, American Heart JournalCitation Excerpt :Similarly, race and perceived harm have been proposed as barriers to participation in randomized controlled trials.28 Insurance coverage has implications in trial enrollment and subsequently clinical trial outcomes.29 For example, because of aspects of the US health care system, insurance coverage has been found to be a significant predictor of US enrollment for oncology trials.30
Insurance status and outcome after intracerebral hemorrhage: Findings from get with the Guidelines-stroke
2014, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :Little is known about the relationships between a patient's insurance status, medical treatment, and outcome after hospitalization for ICH. Analysis of a large cohort of patients suffering from ICH may clarify whether potential disparities correlate with insurance status, as has been shown in other areas of medicine.12 The purpose of this study was to examine associations between a patient's health insurance status (Private insurance, Medicare, Medicaid, or None) and the quality of care delivered and early outcome measures after ICH.
Effect of joint national committee VII report on hospitalizations for hypertensive emergencies in the United States
2011, American Journal of CardiologyCitation Excerpt :The significant predictors of mortality in our study were older age, female gender, the presence of co-morbidities, and the government as the primary payer or uninsured status. Insurance status continues to be associated with a lower use of cardiovascular procedures and, hence, adverse outcomes for patients with cardiovascular disease,12 perhaps related to a lack of regular healthcare and inadequate or no coverage for medication. Addressing these differences in care and outcomes will require additional effort.
Impact of insurance and hospital ownership on hospital length of stay among patients with ambulatory care-sensitive conditions
2011, Annals of Family MedicineCitation Excerpt :For our current study, however, we excluded individuals who were discharged against medical advice, eliminating it as a possible explanation for our findings. Previous research on in-hospital mortality by insurance status has yielded mixed results, which is probably based on the selection of a few specific diagnoses for study.10,20 Uninsured patients have tended to have higher in-hospital mortality, which was supported in the current study for non-ACSC diagnoses.