title: Variation in prehospital and discharge quality of care among acute myocardial infarction patients at a safety net hospital.
abstract: Outcomes and process of care for acute myocardial infarction (AMI) may vary by sociodemographic status. In particular, both low income and uninsured status are common among patients cared for by the nation's safety net hospitals. These characteristics have been linked with delays in seeking care for an AMI. However, less is known about the characteristics and risk factor control among vulnerable patients prior to their index event. Given this background, we assessed cardiac risk factor control before admission, and evidence-based medical care at discharge, following an index AMI event within an urban safety net hospital. Prior to hospitalization, 25% of patients were not integrated into our safety net system and had suboptimal risk factor control. Despite this, inhospital conformity with AMI performance measures were excellent, with 95% of eligible patients receiving a composite criterion of aspirin and beta-blockers on admission and discharge. A majority of AMI survivors were successfully integrated into our system postdischarge.
authors.affiliation: Department of Patient Safety and Quality, Denver Health, Denver, CO 80204, USA. mori.krantz@dhha.org
authors.forename: Philip S
authors.initials: PS
authors.lastname: Mehler
authors.forename: Allison
authors.initials: A
authors.lastname: Sabel
authors.forename: Amy
authors.initials: A
authors.lastname: Trantanella
authors.forename: Mori J
authors.initials: MJ
authors.lastname: Krantz
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003266:Continuity of Patient Care; D004632:Emergency Medical Services / Q000592:standards* / Q000639:trends; D005260:Female; D054625:Healthcare Disparities; D017052:Hospital Mortality / Q000639:trends; D006779:Hospitals, Public; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000592:standards / Q000639:trends; D010351:Patient Discharge / Q000592:standards* / Q000639:trends; D010360:Patient Transfer / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D012959:Socioeconomic Factors; D014481:United States; D035862:Vulnerable Populations / Q000706:statistics & numerical data