Access to revascularization among patients with acute myocardial infarction in New York City--impact of hospital resources.

Full Abstract

Timely revascularization can improve survival in patients with acute myocardial infarction. Identification of factors associated with increased use of revascularization in appropriate patients could improve outcomes. Using New York City hospital discharge records for 1988-1992 and 1998-2002, we determined revascularization rates for patients hospitalized with MI by neighborhood. Odds ratios for revascularization were estimated using a spatial model adjusting for neighborhood sociodemographic characteristics, while accounting for similarities in the rate of revascularization among geographically adjacent neighborhoods. Only 16 out of 112 New York City hospitals performed coronary revascularization. They were located in 14 of 41 neighborhoods. In general, patients living in neighborhoods with higher percentages of patients admitted to hospitals capable of revascularization service were more likely to be revascularized than those in neighborhoods with low percentages of patients admitted to hospitals with revascularization resources. This was true regardless of neighborhood availability of revascularization, after accounting for neighborhood socioeconomic characteristics and patients' clinical status. Revascularization rates in New York City increased from 1988-1992 to 1998-2002 in every neighborhood and as a whole from 103 to 326 per 1,000 hospitalized AMI patients. This increase was not explained by the addition of new revascularization services. Thus, in New York City, where only certain hospitals can perform revascularization, efficient delivery of patients to hospitals with these resources appears to increase the likelihood of revascularization performance among AMI patients without increasing the number of new hospitals capable of revascularization.

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Author information

Author/s: Fang, Jing (J); Negassa, Abdissa (A); Gern, Robert W (RW); Alderman, Michael H (MH);

Affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA. jfang(-atsign-)cdc.gov

Grants: HS11612-01A1 (Agency:AHRQ HHS)

Journal and publication information

Publication Type: Journal Article; Research Support, U.S. Gov't, P.H.S.

Journal: Journal of urban health : bulletin of the New York Academy of Medicine (J Urban Health), published in United States. (Language: eng)

Reference: 2006-Nov; vol 83 (issue 6) : pp 1085-94

Dates: Created 2006/12/22; Completed 2007/02/28; Revised 2007/12/03;

PMID: 16897417, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Health Services Accessibility - trends
Hospitals - trends
Humans
Markov Chains
Myocardial Infarction - surgery

Myocardial Infarction - surgery
Myocardial Revascularization - trends
New York City - epidemiology
Residence Characteristics
Socioeconomic Factors

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