Patient-centered processes of care and long-term outcomes of myocardial infarction.
OBJECTIVE
To examine whether patients' experiences with nontechnical aspects of care such as patient education and discharge planning are associated with long-term outcomes.


METHODS
Observational cohort study.


METHODS
Twenty-three New Hampshire hospitals during 1996 and 1997.


METHODS
Acute myocardial infarction (AMI) patients (N=2,272) enrolled prior to discharge.


METHODS
Surveys asking about problems with care and health were mailed to patients 1, 3, and 12 months after discharge. Patients were stratified into "worse" or "better" care groups on the basis of their hospital care problem score. Outcomes included self-reported overall health, physical health, mental health, chest pain, and shortness of breath. Other clinical measures were obtained from hospital discharge abstracts.


RESULTS
The 1-, 3-, and 12-month surveys were returned by 1,346 (59.2%), 1,046 (46%), and 964 (42.4%) enrolled patients, respectively. The primary analytic cohort consisted of the 762 patients who completed both the 1- and 12-month surveys. After adjustment for postdischarge health status and other clinical factors, patients experiencing worse hospital care had lower ratings of overall health (48.4 vs 52.5 on 100-point scale; P=.02) and physical health (59.7 vs 68.4; P <.001), and were more likely to have chest pain (odds ratio [OR], 1.6; confidence interval [CI], 1.0 to 2.4; P=.04) 12 months after their AMI than other patients. However, differences in reports of chest pain were reduced if patients reporting worse hospital care had better experiences with subsequent ambulatory care.


CONCLUSIONS
Patients' experiences with nontechnical processes of AMI hospital care are associated with long-term outcomes; however the association between a negative hospital experience and subsequent chest pain may be offset by more positive outpatient experiences.
Fremont
A M
AM
RAND Health, Santa Monica, CA 90407-2138, USA. allen_fremont@rand.org
Cleary
P D
PD
Hargraves
J L
JL
Rowe
R M
RM
Jacobson
N B
NB
Ayanian
J Z
JZ
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge; D010353:Patient Education as Topic; D018802:Patient-Centered Care; D013997:Time Factors