title: Quality of care for acute myocardial infarction at urban safety-net hospitals.
abstract: Safety-net hospitals are experiencing increasing financial strains, possibly affecting their quality of care. We compare quality at safety-net and non-safety-net urban hospitals for Medicare beneficiaries admitted with acute myocardial infarction (AMI). Although safety-net hospitals had modestly higher risk-standardized thirty-day all-cause mortality rates and modestly lower adherence to quality-of-care performance measures than non-safety-net hospitals, there was much heterogeneity among safety-net hospitals and substantial overlap with non-safety-net hospitals. We examine the implications of these findings for the millions of vulnerable Americans who rely on safety-net hospitals for their care.
authors.affiliation: Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York City, USA.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Cha
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Epstein
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.forename: Judith H
authors.initials: JH
authors.lastname: Lichtman
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics*; D017052:Hospital Mortality; D006786:Hospitals, Urban / Q000145:classification / Q000191:economics / Q000592:standards*; D006801:Humans; D008297:Male; D006278:Medicare / Q000331:legislation & jurisprudence / Q000592:standards*; D009203:Myocardial Infarction / Q000191:economics / Q000401:mortality / Q000628:therapy*; D010343:Patient Admission / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D011445:Prospective Payment System / Q000331:legislation & jurisprudence; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D020444:Reimbursement, Disproportionate Share / Q000331:legislation & jurisprudence*; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology; D035862:Vulnerable Populations