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Quality of Care for Acute Myocardial Infarction Patients in U.S. Rural Hospitals
This study focuses on the quality of care for a relatively common reason for hospital admission: acute myocardial infarction (AMI). The study provides a model for examining quality of care in rural hospitals and recommends interventions that can be translated to other medical and surgical conditions. This study also provides valuable information about quality indicators that individual rural hospitals can use to ensure the highest quality care for AMI patients. This study has three aims:
- To identify the degree to which rural hospitals meet the clinical care guidelines for AMI for Medicare beneficiaries;
- To identify hospital characteristics (e.g., volume, degree of rurality, measures of resource availability) associated with higher and lower quality of care and mortality rates for AMI; and
- To develop recommendations for interventions to improve quality of care for AMI in rural hospitals.
The study links existing databases to evaluate the quality of care provided in rural hospitals and examines the hospital characteristics associated with higher and lower quality of care and mortality for AMI after controlling for patient risk factors. Data sources include the Cooperative Cardiovascular Project (CCP) Database for 1994-95, the American Hospital Association, the Annual Survey of Hospitals, and the Area Resource File data. A linked database was created using the sources listed above and includes rural/urban designations. The new Rural-Urban Commuting Area codes (RUCAs) were linked via ZIP code to each patient and hospital in the CCP database so that the degree of rurality could be identified for each. Rates of AMI indicator compliance by rural hospitals were calculated for rural hospitals nationally, and by region, division, and state. The specific indicators on which rural hospitals are less compliant were identified so that interventions to improve quality of care can be developed.
Publications
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Quality of Care for Acute Myocardial Infarction in Rural and Urban U.S. Hospitals
Author(s): Laura-Mae Baldwin, Richard F MacLehose, Shelli K Beaver, N Every, Leighton Chan
Citation: Journal of Rural Health, 20(2), 99-108
Date: 2004
Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care.
Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers. Methods: This cohort study used data from the Cooperative Cardiovascular Project (CCP), including 4,085 acute care hospitals (408 remote small rural, 893 small rural, 619 large rural, and 2,165 urban) with 135,759 direct admissions of Medicare beneficiaries ages 65 and older for a confirmed AMI between February 1994 and July 1995. Outcomes included use of aspirin, reperfusion, heparin, and intravenous nitroglycerin during hospitalization; use of beta-blockers, aspirin, and angiotensin-converting enzyme (ACE) inhibitors at discharge; avoidance of calcium channel blockers at discharge; and 30-day mortality.
Findings: Substantial proportions of Medicare beneficiaries in both urban and rural hospitals did not receive the recommended treatments for AMI. Medicare patients in rural hospitals were less likely than urban hospitals' patients to receive aspirin, intravenous nitroglycerin, heparin, and either thrombolytics or percutaneous transluminal coronary angioplasty. Only ACE inhibitors at discharge was used more for patients in rural hospitals than urban hospitals. Medicare patients in rural hospitals had higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals (odds ratio for large rural 1.14 [1.10 to 1.18], small rural 1.24 [1.20 to 1.29], remote small rural 1.32 [1.23 to 1.41]).
Conclusions: Efforts are needed to help hospital medical staffs in both rural and urban areas develop systems to ensure that patients receive recommended treatments for AMI.
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