Quality of care for acute myocardial infarction at urban safety-net hospitals.
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.
Ross
Joseph S
JS
Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York City, USA.
Cha
Stephen S
SS
Epstein
Andrew J
AJ
Wang
Yongfei
Y
Bradley
Elizabeth H
EH
Herrin
Jeph
J
Lichtman
Judith H
JH
Normand
Sharon-Lise T
SL
Masoudi
Frederick A
FA
Krumholz
Harlan M
HM
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