Insurance Status and the Treatment of Myocardial Infarction at Academic Centers

Brian C. Hiestand, Dawn M. Prall, Christopher J. Lindsell, James W. Hoekstra, Charles V. Pollack, Judd E. Hollander, Brian R. Tiffany, W. Frank Peacock, Deborah B. Diercks, W. Brian Gibler

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Numerous studies have documented treatment disparities in patients with acute coronary syndromes based on race and gender. Other causes for treatment disparities may exist. Objectives: To determine if insurance status affects quality of care in patients with acute myocardial infarction (AMI) presenting to academic health centers. Methods: The Internet Tracking Registry for Acute Coronary Syndromes (i*trACS), a prospective multicenter registry of patients with chest pain presenting to the emergency department who receive an electrocardiogram, was used as the database (N = 17,737). A subset of patients who were diagnosed as having AMI were selected from the database (n = 936). Patients were classified as having either ST-segment elevation MI (n = 178) or non-ST-segment elevation MI (n = 758). Insurance status, age, race, and gender were extracted as predictor variables. The influence of predictor variables on treatment modality was investigated using logistic regression, adjusted for clustering within sites. Results: The odds of a self-pay patient with ST-segment elevation MI receiving fibrinolytics were 3.23 (95% CI = 1.56 to 6.69) times higher than for other patients. Patients with Medicare coverage were less likely to receive fibrinolytics (odds ratio [OR] 0.35, 95% CI = 0.19 to 0.65) and tended to undergo percutaneous coronary intervention less often (OR 0.60, 95% CI = 0.36 to 1.01). The odds of a privately insured patient's receiving coronary artery bypass grafting (OR 2.76, 95% CI = 1.62 to 4.72) or percutaneous coronary intervention (OR 1.47, 95% CI = 1.03 to 2.11) were higher than for other patients. Conclusions: Insurance coverage appears to affect treatment in patients with AMI, with self-pay patients more likely to receive less-expensive therapies and insured patients more likely to receive invasive treatments.

Original languageEnglish (US)
Pages (from-to)343-348
Number of pages6
JournalAcademic Emergency Medicine
Volume11
Issue number4
DOIs
StatePublished - Apr 2004

Fingerprint

Insurance Coverage
Myocardial Infarction
Therapeutics
Odds Ratio
Percutaneous Coronary Intervention
Acute Coronary Syndrome
Registries
Databases
Quality of Health Care
Medicare
Chest Pain
Coronary Artery Bypass
Internet
Cluster Analysis
Hospital Emergency Service
Electrocardiography

Keywords

  • Coronary disease
  • Health services accessibility
  • Insurance

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Hiestand, B. C., Prall, D. M., Lindsell, C. J., Hoekstra, J. W., Pollack, C. V., Hollander, J. E., ... Gibler, W. B. (2004). Insurance Status and the Treatment of Myocardial Infarction at Academic Centers. Academic Emergency Medicine, 11(4), 343-348. https://doi.org/10.1197/j.aem.2003.12.017

Insurance Status and the Treatment of Myocardial Infarction at Academic Centers. / Hiestand, Brian C.; Prall, Dawn M.; Lindsell, Christopher J.; Hoekstra, James W.; Pollack, Charles V.; Hollander, Judd E.; Tiffany, Brian R.; Peacock, W. Frank; Diercks, Deborah B.; Gibler, W. Brian.

In: Academic Emergency Medicine, Vol. 11, No. 4, 04.2004, p. 343-348.

Research output: Contribution to journalArticle

Hiestand, BC, Prall, DM, Lindsell, CJ, Hoekstra, JW, Pollack, CV, Hollander, JE, Tiffany, BR, Peacock, WF, Diercks, DB & Gibler, WB 2004, 'Insurance Status and the Treatment of Myocardial Infarction at Academic Centers', Academic Emergency Medicine, vol. 11, no. 4, pp. 343-348. https://doi.org/10.1197/j.aem.2003.12.017
Hiestand BC, Prall DM, Lindsell CJ, Hoekstra JW, Pollack CV, Hollander JE et al. Insurance Status and the Treatment of Myocardial Infarction at Academic Centers. Academic Emergency Medicine. 2004 Apr;11(4):343-348. https://doi.org/10.1197/j.aem.2003.12.017
Hiestand, Brian C. ; Prall, Dawn M. ; Lindsell, Christopher J. ; Hoekstra, James W. ; Pollack, Charles V. ; Hollander, Judd E. ; Tiffany, Brian R. ; Peacock, W. Frank ; Diercks, Deborah B. ; Gibler, W. Brian. / Insurance Status and the Treatment of Myocardial Infarction at Academic Centers. In: Academic Emergency Medicine. 2004 ; Vol. 11, No. 4. pp. 343-348.
@article{8479d8a8fc3b4805b7beaa3cd85befc1,
title = "Insurance Status and the Treatment of Myocardial Infarction at Academic Centers",
abstract = "Numerous studies have documented treatment disparities in patients with acute coronary syndromes based on race and gender. Other causes for treatment disparities may exist. Objectives: To determine if insurance status affects quality of care in patients with acute myocardial infarction (AMI) presenting to academic health centers. Methods: The Internet Tracking Registry for Acute Coronary Syndromes (i*trACS), a prospective multicenter registry of patients with chest pain presenting to the emergency department who receive an electrocardiogram, was used as the database (N = 17,737). A subset of patients who were diagnosed as having AMI were selected from the database (n = 936). Patients were classified as having either ST-segment elevation MI (n = 178) or non-ST-segment elevation MI (n = 758). Insurance status, age, race, and gender were extracted as predictor variables. The influence of predictor variables on treatment modality was investigated using logistic regression, adjusted for clustering within sites. Results: The odds of a self-pay patient with ST-segment elevation MI receiving fibrinolytics were 3.23 (95{\%} CI = 1.56 to 6.69) times higher than for other patients. Patients with Medicare coverage were less likely to receive fibrinolytics (odds ratio [OR] 0.35, 95{\%} CI = 0.19 to 0.65) and tended to undergo percutaneous coronary intervention less often (OR 0.60, 95{\%} CI = 0.36 to 1.01). The odds of a privately insured patient's receiving coronary artery bypass grafting (OR 2.76, 95{\%} CI = 1.62 to 4.72) or percutaneous coronary intervention (OR 1.47, 95{\%} CI = 1.03 to 2.11) were higher than for other patients. Conclusions: Insurance coverage appears to affect treatment in patients with AMI, with self-pay patients more likely to receive less-expensive therapies and insured patients more likely to receive invasive treatments.",
keywords = "Coronary disease, Health services accessibility, Insurance",
author = "Hiestand, {Brian C.} and Prall, {Dawn M.} and Lindsell, {Christopher J.} and Hoekstra, {James W.} and Pollack, {Charles V.} and Hollander, {Judd E.} and Tiffany, {Brian R.} and Peacock, {W. Frank} and Diercks, {Deborah B.} and Gibler, {W. Brian}",
year = "2004",
month = "4",
doi = "10.1197/j.aem.2003.12.017",
language = "English (US)",
volume = "11",
pages = "343--348",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Insurance Status and the Treatment of Myocardial Infarction at Academic Centers

AU - Hiestand, Brian C.

AU - Prall, Dawn M.

AU - Lindsell, Christopher J.

AU - Hoekstra, James W.

AU - Pollack, Charles V.

AU - Hollander, Judd E.

AU - Tiffany, Brian R.

AU - Peacock, W. Frank

AU - Diercks, Deborah B.

AU - Gibler, W. Brian

PY - 2004/4

Y1 - 2004/4

N2 - Numerous studies have documented treatment disparities in patients with acute coronary syndromes based on race and gender. Other causes for treatment disparities may exist. Objectives: To determine if insurance status affects quality of care in patients with acute myocardial infarction (AMI) presenting to academic health centers. Methods: The Internet Tracking Registry for Acute Coronary Syndromes (i*trACS), a prospective multicenter registry of patients with chest pain presenting to the emergency department who receive an electrocardiogram, was used as the database (N = 17,737). A subset of patients who were diagnosed as having AMI were selected from the database (n = 936). Patients were classified as having either ST-segment elevation MI (n = 178) or non-ST-segment elevation MI (n = 758). Insurance status, age, race, and gender were extracted as predictor variables. The influence of predictor variables on treatment modality was investigated using logistic regression, adjusted for clustering within sites. Results: The odds of a self-pay patient with ST-segment elevation MI receiving fibrinolytics were 3.23 (95% CI = 1.56 to 6.69) times higher than for other patients. Patients with Medicare coverage were less likely to receive fibrinolytics (odds ratio [OR] 0.35, 95% CI = 0.19 to 0.65) and tended to undergo percutaneous coronary intervention less often (OR 0.60, 95% CI = 0.36 to 1.01). The odds of a privately insured patient's receiving coronary artery bypass grafting (OR 2.76, 95% CI = 1.62 to 4.72) or percutaneous coronary intervention (OR 1.47, 95% CI = 1.03 to 2.11) were higher than for other patients. Conclusions: Insurance coverage appears to affect treatment in patients with AMI, with self-pay patients more likely to receive less-expensive therapies and insured patients more likely to receive invasive treatments.

AB - Numerous studies have documented treatment disparities in patients with acute coronary syndromes based on race and gender. Other causes for treatment disparities may exist. Objectives: To determine if insurance status affects quality of care in patients with acute myocardial infarction (AMI) presenting to academic health centers. Methods: The Internet Tracking Registry for Acute Coronary Syndromes (i*trACS), a prospective multicenter registry of patients with chest pain presenting to the emergency department who receive an electrocardiogram, was used as the database (N = 17,737). A subset of patients who were diagnosed as having AMI were selected from the database (n = 936). Patients were classified as having either ST-segment elevation MI (n = 178) or non-ST-segment elevation MI (n = 758). Insurance status, age, race, and gender were extracted as predictor variables. The influence of predictor variables on treatment modality was investigated using logistic regression, adjusted for clustering within sites. Results: The odds of a self-pay patient with ST-segment elevation MI receiving fibrinolytics were 3.23 (95% CI = 1.56 to 6.69) times higher than for other patients. Patients with Medicare coverage were less likely to receive fibrinolytics (odds ratio [OR] 0.35, 95% CI = 0.19 to 0.65) and tended to undergo percutaneous coronary intervention less often (OR 0.60, 95% CI = 0.36 to 1.01). The odds of a privately insured patient's receiving coronary artery bypass grafting (OR 2.76, 95% CI = 1.62 to 4.72) or percutaneous coronary intervention (OR 1.47, 95% CI = 1.03 to 2.11) were higher than for other patients. Conclusions: Insurance coverage appears to affect treatment in patients with AMI, with self-pay patients more likely to receive less-expensive therapies and insured patients more likely to receive invasive treatments.

KW - Coronary disease

KW - Health services accessibility

KW - Insurance

UR - http://www.scopus.com/inward/record.url?scp=12144286752&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=12144286752&partnerID=8YFLogxK

U2 - 10.1197/j.aem.2003.12.017

DO - 10.1197/j.aem.2003.12.017

M3 - Article

C2 - 15064206

AN - SCOPUS:12144286752

VL - 11

SP - 343

EP - 348

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 4

ER -