Admissions for CABG procedure in the elderly: was there a change in access to teaching hospitals after 1997?
ABSTRACT The purpose of the study is to identify patient attributes associated with teaching hospital admissions in the elderly for coronary artery bypass graft (CABG), and to determine whether admission patterns in teaching hospitals by vulnerable subgroups of the elderly changed during 1997 to 2001, a period with significant changes in CABG admission patterns and financial situation faced by teaching hospitals. The study sample comprises elderly residents in two states, New York and Pennsylvania, and uses Healthcare Cost and Utilization Project State Inpatient data of the Agency for Health Care Research and Quality. Patient characteristics in major teaching hospitals are compared with those in rest of hospitals in a logistic regression framework using a pre-/postdesign, and controlling for county characteristics and resources, distance to hospitals, and hospital size and volume of procedures. Significant patient characteristics associated with a higher likelihood of admission to teaching hospitals included racial/ethnic minority status, transfer cases, Medicaid and private health maintenance organization insurance. A lower volume of CABG cases and an increased propensity to admit more complex cases characterized the admission patterns in teaching hospitals during 1997 to 2001. Although higher use of teaching hospitals by racial/ethnic minorities persisted, access for Medicaid patients disproportionately declined.
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ABSTRACT: The study examines the variation and changes in preventable hospitalization (PH) rates across small areas over 1995-2005 in 5 US states for adults (aged 18-64 years). Using hospital discharge data from the Agency for Healthcare Research and Quality and contextual data from Health Resources and Services Administration, the study examines the role of managed care, primary care physician supply, and sociodemographic factors on adult PH rates. A stronger influence of minority and uninsured status, weaker contributions of managed care enrollment in the commercial as well as in the Medicaid markets, and weaker contributions of primary care density may have caused slower than expected reduction in adult PH rates.The Journal of ambulatory care management 07/2012; 35(3):226-37. DOI:10.1097/JAC.0b013e3182456836