TY - JOUR
T1 - Associations of patient demographic characteristics and regional physician density with early physician follow-up among medicare beneficiaries hospitalized with heart failure
AU - Kociol, Robb D.
AU - Greiner, Melissa A.
AU - Fonarow, Gregg C.
AU - Hammill, Bradley G.
AU - Heidenreich, Paul A.
AU - Yancy, Clyde W.
AU - Peterson, Eric D.
AU - Curtis, Lesley H.
AU - Hernandez, Adrian F.
N1 - Funding Information:
Get With The Guidelines-Heart Failure is a program of the American Heart Association, Dallas, Texas, and is supported in part by an unrestricted educational grant from Medtronic , Minneapolis, Minnesota. OPTIMIZE-HF and GWTG-HF were previously supported by GlaxoSmithKline, Brentford, Middlesex, United Kingdom. This work was supported by Award 087512N from the American Heart Association-Pharmaceutical Roundtable and David and Stevie Spina, Dallas, Texas. Dr. Hernandez was supported by Award 0675060N from the American Heart Association-Pharmaceutical Roundtable and David and Stevie Spina. Dr. Peterson and Dr. Curtis were supported by Grant U18HS016964 from the Agency for Healthcare Research and Quality , Rockville, Maryland.
PY - 2011/10/1
Y1 - 2011/10/1
N2 - Early physician follow-up after a heart failure (HF) hospitalization is associated with lower risk of readmission. However, factors associated with early physician follow-up are not well understood. We identified 30,136 patients with HF <65 years at 225 hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE) registry or the Get With The Guidelines-Heart Failure (GWTG-HF) registry from January 1, 2003 through December 31, 2006. We linked these clinical data to Medicare claims data for longitudinal follow-up. Using logistic regression models with site-level random effects, we identified predictors of physician follow-up within 7 days of hospital discharge. Overall 11,420 patients (37.9%) had early physician follow-up. Patients residing in hospital referral regions with higher physician concentration were significantly more likely to have early follow-up (odds ratio 1.29, 95% confidence interval 1.12 to 1.48, for highest vs lowest quartile). Patients in rural areas (0.84, 0.78 to 0.91) and patients with lower socioeconomic status (0.79, 0.74 to 0.85) were less likely to have early follow-up. Women (0.87, 0.83 to 0.91) and black patients (0.84, 0.77 to 0.92) were less likely to receive early follow-up. Patients with greater co-morbidity were less likely to receive early follow-up. In conclusion, physician follow-up within 7 days after discharge from a HF hospitalization varied according to regional physician density, rural location, socioeconomic status, gender, race, and co-morbid conditions. Strategies are needed to ensure access among vulnerable populations to this supply-sensitive resource.
AB - Early physician follow-up after a heart failure (HF) hospitalization is associated with lower risk of readmission. However, factors associated with early physician follow-up are not well understood. We identified 30,136 patients with HF <65 years at 225 hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE) registry or the Get With The Guidelines-Heart Failure (GWTG-HF) registry from January 1, 2003 through December 31, 2006. We linked these clinical data to Medicare claims data for longitudinal follow-up. Using logistic regression models with site-level random effects, we identified predictors of physician follow-up within 7 days of hospital discharge. Overall 11,420 patients (37.9%) had early physician follow-up. Patients residing in hospital referral regions with higher physician concentration were significantly more likely to have early follow-up (odds ratio 1.29, 95% confidence interval 1.12 to 1.48, for highest vs lowest quartile). Patients in rural areas (0.84, 0.78 to 0.91) and patients with lower socioeconomic status (0.79, 0.74 to 0.85) were less likely to have early follow-up. Women (0.87, 0.83 to 0.91) and black patients (0.84, 0.77 to 0.92) were less likely to receive early follow-up. Patients with greater co-morbidity were less likely to receive early follow-up. In conclusion, physician follow-up within 7 days after discharge from a HF hospitalization varied according to regional physician density, rural location, socioeconomic status, gender, race, and co-morbid conditions. Strategies are needed to ensure access among vulnerable populations to this supply-sensitive resource.
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U2 - 10.1016/j.amjcard.2011.05.032
DO - 10.1016/j.amjcard.2011.05.032
M3 - Article
C2 - 21791327
AN - SCOPUS:80052704383
SN - 0002-9149
VL - 108
SP - 985
EP - 991
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 7
ER -