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| Publications [#86271] of Lesley H Curtis
Papers Published
- FA Sloan, JG Trogdon, LH Curtis, KA Schulman, Does the ownership of the admitting hospital make a difference? Outcomes and process of care of Medicare beneficiaries admitted with acute myocardial infarction.,
Medical care, United States, vol. 41 no. 10
(October, 2003),
pp. 1193-205, ISSN 0025-7079
(last updated on 2007/11/29)
Abstract:
BACKGROUND: Concerns have been expressed about quality of for-profit hospitals and their use of expensive technologies. OBJECTIVE: To determine differences in mortality after admission for acute myocardial infarction (AMI) and in the use of low- and high-tech services for AMI among for-profit, public, and private nonprofit hospitals. STUDY DESIGN, SETTING, AND PATIENTS: Cooperative Cardiovascular Project data for 129,092 Medicare patients admitted for AMI from 1994 to 1995. MAIN OUTCOME MEASURES: Mortality at 30 days and 1 year postadmission; use of aspirin, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers at discharge, thrombolytic therapy, catheterization, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass graft (CABG) compared by ownership. RESULTS: Mortality rates at 30 days and at 1 year at for-profit hospitals were no different from those at public and private nonprofit hospitals. Without patient illness variables, nonprofit hospitals had lower mortality rates at 30 days (relative risk [RR], 0.95; 95% confidence interval [CI], 0.91-0.99) and at 1 year (RR, 0.96; 95% CI, 0.93-0.99) than did for-profit hospitals, but there was no difference in mortality between public and for-profit hospitals. Beneficiaries at nonprofit hospitals were more likely to receive aspirin (RR, 1.04; 95% CI, 1.03-1.05) and ACE inhibitors (RR, 1.05; 95% CI, 1.02-1.08) than at for-profit hospitals, but had lower rates of PTCA (RR, 0.91; 95% CI, 0.86-0.96) and CABG (RR, 0.93; 95% CI, 0.86-1.00). CONCLUSIONS: Although outcomes did not vary by ownership, for-profit hospitals were more likely to use expensive, high-tech procedures. This pattern appears to be the result of for-profit hospitals' propensity to locate in areas with demand for high-tech care for AMI.
Keywords:
Aged • Cardiovascular Surgical Procedures • Diagnostic Techniques, Cardiovascular • Female • Hospital Mortality • Hospitals, Private • Humans • Male • Medicare • Myocardial Infarction • Outcome and Process Assessment (Health Care) • Ownership • Patient Admission • Socioeconomic Factors • United States • diagnosis • epidemiology • mortality • statistics & numerical data • statistics & numerical data* • therapy*
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