No pain, but no gain? The disappearance of angina hospitalizations, 1992-1999.
BACKGROUND
Hospitalization for angina is commonly considered an ambulatory care sensitive hospitalization and used as a measure of access to primary care.


OBJECTIVE
To analyze time trends in angina-related hospitalizations and seek possible explanations for an observed, marked decline during 1992 to 1999.


METHODS
We analyzed Medicare claims of SEER-Medicare control subjects for occurrence of angina hospital discharges, using the Agency for Healthcare Research and Quality Prevention Quality Indicator (PQI) definition, along with occurrence of related events including angina admissions with revascularization, angina admissions discharged as coronary artery disease (CAD) or myocardial infarction, and overall ischemic heart disease discharges.


METHODS
Approximately 124,000 cancer-free Medicare beneficiary/ies, with subjects contributing data for 1 to 8 years.


RESULTS
Angina PQI hospital discharges declined 75% between 1992 and 1999. CAD hospital discharges rose in a reciprocal pattern, while angina discharges with revascularization declined and discharges for myocardial infarction and ischemic heart disease were relatively constant during this time period.


CONCLUSIONS
The marked decline in angina PQI hospital discharges during 1992-1999 does not appear to represent improvements in access to care or prevention of heart disease, but rather increased coding of more specific discharge diagnoses for CAD. Our findings suggest that angina hospitalization is not a valid measure for monitoring access to care and, more generally, demonstrate the need for careful, periodic re-evaluation of quality measures.
Saver
Barry G
BG
Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts 01655-0002, USA. barry.saver@umassmed.edu
Dobie
Sharon A
SA
Green
Pamela K
PK
Wang
Ching-Yun
CY
Baldwin
Laura-Mae
LM
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis* / Q000453:epidemiology; D003625:Data Collection; D005260:Female; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008297:Male; D006278:Medicare; D010351:Patient Discharge / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D014481:United States / Q000453:epidemiology