Payer Status and the Utilization of Hospital Resources in Acute Myocardial Infarction

Canto, John G.; Rogers, William J.; French, William J.; Gore, Joel M.; Chandra, Nisha; Barron, Hal V.

doi:10.1001/archinte.160.6.817

Cited by 102 publications

(80 citation statements)

References 20 publications

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“…This reflects previous reports on this topic. [6][7][8][9] Also similar to prior studies, 35,36 payor status was associated with PLOS in our analysis. Because maintaining airway pressures of 10 cm H 2 O has been observed to significantly reduce atelectasis, pneumonia, and reintubation, 37,38 prophylactic continuous positive airway pressure may benefit COPD patients following CABG.…”

Section: Discussionsupporting

confidence: 86%

Long-Term Survival after Cardiac Surgery in Patients with Chronic Obstructive Pulmonary Disease

Efird

Griffin

O’Neal

et al. 2016

American Journal of Critical Care

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Background Although many patients with chronic obstructive pulmonary disease (COPD) require a prolonged length of stay (PLOS) following coronary artery bypass grafting (CABG), the impact of PLOS on long-term survival has not been examined in this population. Objectives To determine the association between PLOS and long-term survival among COPD and non-COPD patients after CABG and to examine consequent policy and practice-based implications. Methods A retrospective cohort study of CABG patients was conducted between 2002 and 2011. Long-term survival was compared in patients with and without COPD and stratified by PLOS. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. Conclusions COPD and PLOS are 2 of many factors that affect long-term mortality in postoperative CABG patients. Aggressive treatment strategies aimed at early weaning off of mechanical ventilation and prevention of reintubation among COPD patients must be considered carefully as a means to reduce length of stay after CABG. Our results also have important implications for the long-term management of these patients and strategies for containing costs over the life course of the patient.

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Section: Discussionsupporting

confidence: 86%

Long-Term Survival after Cardiac Surgery in Patients with Chronic Obstructive Pulmonary Disease

Efird

Griffin

O’Neal

et al. 2016

American Journal of Critical Care

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“…Further disparities in PCI utilization were revealed with private insurance holders were more likely to receive PCI as compared to government sponsored insurance holders (Medicare/Medicaid). Similar results have been demonstrated by Canto et al [34] in ACS patients. Our study also supported the "weekend effect" leading to less PCI on patients admitted during weekend as compared to weekdays and as predicted mortality is higher in these patients.…”

Section: Discussionsupporting

confidence: 91%

Impact of Percutaneous Coronary Intervention on in Hospital Mortality in Cardiac Arrest – A National Perspective

Tripathi¹,

Arora²,

Panaich³

et al. 2016

Angiol

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“…In a study of inpatient hospital resource use, Canto et al 33 observed that Medicaid-insured patients with acute myocardial infarction received fewer reperfusion therapies, underwent fewer invasive cardiac procedures, and had longer hospitalizations than Medicare-insured patients. Although these procedures have a discretionary component, they also may be less likely for patients who are in poor health.…”

Section: Discussionmentioning

confidence: 99%

Insurance and inpatient care

Dahman

Bear

2012

Cancer

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BACKGROUND: Early research demonstrated that patients' length-of-stay and inpatient costs varied according to their health insurance status. The authors of the current report studied a population-based sample of privately insured, Medicaid-insured, and uninsured inpatients ages 21 to 64 years who underwent surgical resection for either nonsmall cell lung cancer (NSCLC) (n ¼ 781) or colorectal cancer (CRC) (n ¼ 8190) or who underwent mastectomy (n ¼ 6201) to compare length of stay and inpatient costs by insurance status. METHODS: Data for this study were derived from all civilian, acute-care hospitals in Virginia from 1999 to 2005. Hierarchical generalized linear models were used to estimate the relation between the explanatory variables and lengths of stay and costs. All analyses controlled for patient characteristics and hospital random effects. RESULTS: Medicaid-insured patients with NSCLC had longer lengths of stay (39% or 2.64 days longer) and higher inpatient costs (20% or $2479 higher costs). Uninsured and Medicaidinsured patients with CRC had longer lengths of stay and higher inpatient costs. In contrast, uninsured patients with breast cancer had 11% shorter lengths of stay and 12% lower inpatient costs than privately insured patients. Medicaid-insured patients had 10% lower inpatient costs than privately insured patients. Differences were no longer statistically significant when reconstruction was added to the models. CONCLUSIONS: Health insurance affected the need for health care and the amount of health care received. Uninsured and Medicaid-insured patients with lung cancer and colon cancer who underwent resection had longer lengths of stay and higher inpatient costs than privately insured patients, but they had shorter lengths of stay when reconstruction was not provided. Among the patients with breast cancer, patients and/or providers economized on discretionary procedures. Cancer 2012;118:5084-91. V C 2012American Cancer Society.KEYWORDS: disparities, cancer, Medicaid, uninsured. INTRODUCTIONAs the United States grapples with medical care cost containment and simultaneously seeks ways to provide care for its estimated 52 million uninsured, 1 health care costs continue to rise, and disparities in health outcomes are widespread. Studies have tested the hypothesis that, in the absence of a third-party payer, hospitals and/or patients economize on unneeded procedures. Most of those studies have demonstrated that inpatient charges and lengths of stay are shortest for the uninsured followed by the Medicaid-insured relative to charges and lengths of stay for privately insured patients. [2][3][4][5] Nationwide, hospital stays are shorter for uninsured patients. 6 Such evidence is sometimes interpreted as support for the belief that hospitals offer services in response to financial incentives rather than services based solely on patient need. 7 Inpatient mortality often is greater for uninsured and Medicaid-insured patients relative to their privately insured counterparts, 4,5,8 suggesting that these patient...

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Payer Status and the Utilization of Hospital Resources in Acute Myocardial Infarction

Abstract: This report suggests significant variation by payer status in the management of AMI throughout the United States, but no important differences in mortality among the 3 largest payer groups.

Cited by 102 publications

References 20 publications

Long-Term Survival after Cardiac Surgery in Patients with Chronic Obstructive Pulmonary Disease

Long-Term Survival after Cardiac Surgery in Patients with Chronic Obstructive Pulmonary Disease

Impact of Percutaneous Coronary Intervention on in Hospital Mortality in Cardiac Arrest – A National Perspective

Insurance and inpatient care

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