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Patient Safety and Quality

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Medicare/Medicaid patients with unstable angina receive poorer quality of care than other Medicare patients

A new study found that patients with unstable angina who are insured through both Medicare and Medicaid appear to receive poorer quality of care than patients who have Medicare only or Medicare plus private supplemental insurance. Even after adjustment for demographics and hospital characteristics, Medicare/Medicaid patients (who had more severe heart disease) were 43 percent less likely to see a cardiologist, 34 percent less likely to receive antiplatelet therapy such as aspirin within 24 hours of admission, and 29 percent less likely to receive the blood thinner heparin than other Medicare patients.

Medicare/Medicaid patients were also 32 percent less likely to undergo coronary angiography. However, after adjusting for hospital characteristics, including cardiac catheterization capability (which is needed for coronary angiography), this difference was no longer observed. All Medicare patients received an electrocardiogram within 20 minutes of admission. Beta-blockers were used least in the Medicare-only patients, with only 38 percent of elderly patients receiving them.

These findings were based on retrospective comparison of several measures of quality of care using data from the medical charts of 3,122 black or white Medicare patients over 65 years of age who were hospitalized for unstable angina in 22 Alabama hospitals from 1993 to 1999. Medicare/Medicaid patients were more often black, female, over 85 years old, had multiple medical conditions, or were admitted to hospitals without cardiac catheterization facilities. The study was supported by the Agency for Healthcare Research and Quality (HS08843).

See "Disparities by insurance status in quality of care for elderly patients with unstable angina," by Salpy V. Pamboukian, M.D., M.S.P.H., Ellen Funkhouser, Dr.P.H., Ian G. Child, M.H.S.A., and others, in the Autumn 2006 Ethnicity & Disease 16, pp. 799-807.

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