title: Comparison of use of medications after acute myocardial infarction in the Veterans Health Administration and Medicare.
abstract: BACKGROUND
  There is concern that care provided in the Veterans Health Administration (VA) may be of poorer quality than non-VA health care. We compared use of medications after acute myocardial infarction in the VA with that in non-VA healthcare settings under fee-for-service (FFS) Medicare financing.
  
  
  RESULTS
  We used clinical data from 2486 VA and 29 249 FFS men >65 years old discharged with a confirmed diagnosis of acute myocardial infarction from 81 VA hospitals and 1530 non-VA hospitals. We reported odds ratios (ORs) for use of thrombolytics, beta-blockers, ACE inhibitors, or aspirin among ideal candidates adjusted for age, sample design (hospital academic affiliation, availability of cardiac procedures, and volume), and within-hospital clustering. Ideal VA candidates were more likely to undergo thrombolytic therapy at arrival (OR [VA relative to Medicare] 1.40 [1.05, 1.74]) or to receive ACE inhibitors (OR 1.67 [1.12, 2.45]) or aspirin (OR 2.32 [1.81, 3.01]) at discharge and equally likely to receive beta-blockers (OR 1.09 [1.03, 1.40]) at discharge.
  
  
  CONCLUSIONS
  Ideal candidates in VA were at least as likely as those in FFS to receive medical therapies of known benefit for acute myocardial infarction.
authors.affiliation: Houston Center for Quality of Care and Utilization Studies, a Health Services Research and Development Center of Excellence, Houston VAMedical Center, Houston, TX 77030, USA. laurap@bcm.tmc.edu.
authors.forename: L A
authors.initials: LA
authors.lastname: Petersen
authors.forename: S L
authors.initials: SL
authors.lastname: Normand
authors.forename: L L
authors.initials: LL
authors.lastname: Leape
authors.forename: B J
authors.initials: BJ
authors.lastname: McNeil
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D015331:Cohort Studies; D018588:Fee-for-Service Plans; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000188:drug therapy*; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D015912:Thrombolytic Therapy; D014728:Veterans / Q000706:statistics & numerical data
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001241:Aspirin