Influence of insurance type on the use of procedures, medications and hospital outcome in patients with unstable angina: results from the GUARANTEE Registry. Global Unstable Angina Registry and Treatment Evaluation.
OBJECTIVE
The purpose of this study was to investigate whether or not there is an association between managed care insurance and the delivery and outcome of care in patients presenting with unstable angina.


BACKGROUND
The proportion of U.S. patients with managed care health insurance is increasing. This may be associated with recent improvements in the control of health care costs. It is unknown whether or not there is a difference in process of care in angina patients presenting with managed care versus fee-for-service health insurance.


METHODS
We compared baseline characteristics, process and outcome of care in 636 patients with managed care insurance (MC) and 1,404 patients with fee-for-service (FFS) insurance who presented with unstable angina to 35 hospitals participating in the global Unstable Angina Registry and Treatment Evaluation (GUARANTEE) Registry.


RESULTS
Although, there was little difference in baseline characteristics and hospital treatments between cohorts, MC patients were more likely to be discharged on guideline-recommended medications (aspirin and beta-adrenergic blocking agents). In addition, FFS patients were more likely to undergo cardiac catheterization (odds ratio = 1.25 95% confidence interval = 1.1 to 1.5), but not revascularization during the hospitalization. There was no difference in hospital mortality (0.9% versus 1.2% in MC versus FFS; p = 0.60).


CONCLUSIONS
In patients admitted with suspected unstable angina, MC patients are less likely to undergo coronary angiography, but are more likely to be discharged on indicated medications.
Northwest Health Services Research and Development Program, Puget Sound Veteran's Administration Healthcare System, Seattle, Washington, USA. nevery@u.washington.edu
N R
NR
Every
C P
CP
Cannon
C
C
Granger
D J
DJ
Moliterno
F V
FV
Aguirre
J D
JD
Talley
J
J
Booth
S
S
Sapp
J J
JJ
Ferguson
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy / Q000628:therapy*; D001241:Aspirin / Q000627:therapeutic use; D006328:Cardiac Catheterization; D015331:Cohort Studies; D016001:Confidence Intervals; D017023:Coronary Angiography; D003363:Cost Control; D018588:Fee-for-Service Plans / Q000191:economics; D005260:Female; D017048:Health Care Costs; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D008875:Middle Aged; D009204:Myocardial Revascularization; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000191:economics; D010351:Patient Discharge; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012042:Registries; D016896:Treatment Outcome; D014481:United States
D000319:Adrenergic beta-Antagonists; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin