Quality of ambulatory care after myocardial infarction among Medicare patients by type of insurance and region

Am J Med. 2001 Jul;111(1):24-32. doi: 10.1016/s0002-9343(01)00741-0.

Abstract

Purpose: To evaluate use of effective cardiac medications and rehabilitation after myocardial infarction in the ambulatory setting in health maintenance organizations (HMOs) and fee-for-service care, and by region.

Subjects and methods: We surveyed elderly Medicare patients during 1996 and 1997 in California (n = 516), Florida (n = 304), and the Northeast (n = 220; Massachusetts, New York, and Pennsylvania) approximately 18 months after myocardial infarction. We assessed use of cardiac medications and rehabilitation for HMO (n = 520) and fee-for-service (n = 520) patients matched by age, sex, month of infarct, and region.

Results: Across all regions, similar proportions of HMO and fee-for-service patients were using aspirin (72%, n = 374 vs. 74%, n = 387), beta-blockers (38%, n = 195 vs. 32%, n = 168), angiotensin-converting enzyme inhibitors (31%, n = 159 vs. 29%, n = 148), cholesterol-lowering agents (28%, n = 146 vs. 30%, n = 157), and calcium channel blockers (31%, n = 162 vs. 31%, n = 159; all P >0.07), except in California where more HMO patients received beta-blockers (36%, n = 93 vs. 26%, n = 66, P = 0.01). In adjusted analyses, use of these drugs did not differ significantly between HMO and fee-for-service patients. Substantial regional differences were evident in the use of beta-blockers (Northeast 46%, n = 102; Florida 34%, n = 102; California 31%, n = 159) and cholesterol-lowering agents (California 35%, n = 182; Florida 24%, n = 73; Northeast 22%, n = 48; each P <0.001). Fee-for-service patients were more likely than HMO patients to receive cardiac rehabilitation in unadjusted (32%, n = 167, vs. 22%, n = 141, P = 0.001) and adjusted analyses.

Conclusions: Both HMO and fee-for-service patients would likely benefit from greater use of beta-blockers and cholesterol-lowering agents. Professional fees for cardiac rehabilitation may promote increased use among fee-for-service patients. Future studies should assess the quality of ambulatory cardiac care in different types of HMOs and the reasons for geographic variations in cardiac drug use.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage
  • Aged
  • Ambulatory Care / standards*
  • Anticholesteremic Agents / administration & dosage
  • Aspirin / administration & dosage
  • Calcium Channel Blockers / administration & dosage
  • California / epidemiology
  • Comorbidity
  • Drug Prescriptions / statistics & numerical data
  • Educational Status
  • Ethnicity / statistics & numerical data
  • Fee-for-Service Plans / standards*
  • Female
  • Florida / epidemiology
  • Health Maintenance Organizations / standards*
  • Humans
  • Income
  • Male
  • Medicare / standards*
  • Multivariate Analysis
  • Myocardial Infarction / drug therapy*
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / prevention & control
  • Myocardial Infarction / rehabilitation
  • New England / epidemiology
  • Quality of Health Care*
  • Surveys and Questionnaires
  • United States

Substances

  • Adrenergic beta-Antagonists
  • Anticholesteremic Agents
  • Calcium Channel Blockers
  • Aspirin