Underutilization of percutaneous coronary intervention for ST-elevation myocardial infarction in medicaid patients relative to private insurance patients

Edward L. Hannan, Ye Zhong, Gary Walford, Alice K. Jacobs, Ferdinand J. Venditti, Nicholas J. Stamato, David Holmes, Samin Sharma, Foster Gesten, Spencer B. King

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective To determine whether disparities in access to invasive cardiac procedures still exist for Medicaid patients, given how old earlier studies are and given changes in the interim in appropriateness guidelines. Patients and Methods A total of 5,022 Medicaid and private insurance patients in New York from January 1, 2008 through December 31, 2009 under age 65 with ST-elevation myocardial infarction (STEMI) were compared with regard to their access to percutaneous coronary interventions (PCI) before and after controlling for numerous patient characteristics and other important factors. Results Medicaid patients were significantly less likely to be admitted initially to a hospital certified to perform PCI (90.4% vs. 94.3%, P < 0.001). Also, Medicaid patients were found to be significantly less likely to undergo PCI than other patients (adjusted odds ratio [AOR] = 0.81, 95% CI 0.66, 0.98, P = 0.03). When the probability of each hospital performing PCI for STEMI patients was controlled for, Medicaid patients were still less likely to undergo PCI after controlling for other risk factors (AOR = 0.80, 95% CI 0.65, 0.99, P = 0.04). Conclusions Medicaid STEMI patients are significantly less likely to undergo PCI within the same day of admission as private pay patients even after adjusting for patient characteristics related to receiving PCI, and the strength of this relationship is not diminished when controlling for whether the admitting hospital has approval to perform PCI or controlling for the tendency of the admitting hospital to treat STEMI with PCI.

Original languageEnglish (US)
Pages (from-to)470-481
Number of pages12
JournalJournal of Interventional Cardiology
Volume26
Issue number5
DOIs
StatePublished - Oct 1 2013

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Medicaid
Percutaneous Coronary Intervention
Insurance
ST Elevation Myocardial Infarction
Odds Ratio
Guidelines

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Underutilization of percutaneous coronary intervention for ST-elevation myocardial infarction in medicaid patients relative to private insurance patients. / Hannan, Edward L.; Zhong, Ye; Walford, Gary; Jacobs, Alice K.; Venditti, Ferdinand J.; Stamato, Nicholas J.; Holmes, David; Sharma, Samin; Gesten, Foster; King, Spencer B.

In: Journal of Interventional Cardiology, Vol. 26, No. 5, 01.10.2013, p. 470-481.

Research output: Contribution to journalArticle

Hannan, Edward L. ; Zhong, Ye ; Walford, Gary ; Jacobs, Alice K. ; Venditti, Ferdinand J. ; Stamato, Nicholas J. ; Holmes, David ; Sharma, Samin ; Gesten, Foster ; King, Spencer B. / Underutilization of percutaneous coronary intervention for ST-elevation myocardial infarction in medicaid patients relative to private insurance patients. In: Journal of Interventional Cardiology. 2013 ; Vol. 26, No. 5. pp. 470-481.
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abstract = "Objective To determine whether disparities in access to invasive cardiac procedures still exist for Medicaid patients, given how old earlier studies are and given changes in the interim in appropriateness guidelines. Patients and Methods A total of 5,022 Medicaid and private insurance patients in New York from January 1, 2008 through December 31, 2009 under age 65 with ST-elevation myocardial infarction (STEMI) were compared with regard to their access to percutaneous coronary interventions (PCI) before and after controlling for numerous patient characteristics and other important factors. Results Medicaid patients were significantly less likely to be admitted initially to a hospital certified to perform PCI (90.4{\%} vs. 94.3{\%}, P < 0.001). Also, Medicaid patients were found to be significantly less likely to undergo PCI than other patients (adjusted odds ratio [AOR] = 0.81, 95{\%} CI 0.66, 0.98, P = 0.03). When the probability of each hospital performing PCI for STEMI patients was controlled for, Medicaid patients were still less likely to undergo PCI after controlling for other risk factors (AOR = 0.80, 95{\%} CI 0.65, 0.99, P = 0.04). Conclusions Medicaid STEMI patients are significantly less likely to undergo PCI within the same day of admission as private pay patients even after adjusting for patient characteristics related to receiving PCI, and the strength of this relationship is not diminished when controlling for whether the admitting hospital has approval to perform PCI or controlling for the tendency of the admitting hospital to treat STEMI with PCI.",
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AU - Venditti, Ferdinand J.

AU - Stamato, Nicholas J.

AU - Holmes, David

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AU - Gesten, Foster

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AB - Objective To determine whether disparities in access to invasive cardiac procedures still exist for Medicaid patients, given how old earlier studies are and given changes in the interim in appropriateness guidelines. Patients and Methods A total of 5,022 Medicaid and private insurance patients in New York from January 1, 2008 through December 31, 2009 under age 65 with ST-elevation myocardial infarction (STEMI) were compared with regard to their access to percutaneous coronary interventions (PCI) before and after controlling for numerous patient characteristics and other important factors. Results Medicaid patients were significantly less likely to be admitted initially to a hospital certified to perform PCI (90.4% vs. 94.3%, P < 0.001). Also, Medicaid patients were found to be significantly less likely to undergo PCI than other patients (adjusted odds ratio [AOR] = 0.81, 95% CI 0.66, 0.98, P = 0.03). When the probability of each hospital performing PCI for STEMI patients was controlled for, Medicaid patients were still less likely to undergo PCI after controlling for other risk factors (AOR = 0.80, 95% CI 0.65, 0.99, P = 0.04). Conclusions Medicaid STEMI patients are significantly less likely to undergo PCI within the same day of admission as private pay patients even after adjusting for patient characteristics related to receiving PCI, and the strength of this relationship is not diminished when controlling for whether the admitting hospital has approval to perform PCI or controlling for the tendency of the admitting hospital to treat STEMI with PCI.

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