Acute myocardial infarction and coronary artery bypass grafting outcomes in specialty and general hospitals: analysis of state inpatient data.
OBJECTIVE
Compare characteristics and outcomes of patients hospitalized in specialty cardiac and general hospitals for acute myocardial infarction (AMI) and coronary artery bypass grafting (CABG).


METHODS
2000-2005 all-payor administrative data from Arizona, California, Texas, and Wisconsin.


METHODS
We identified patients admitted to specialty and competing general hospitals with AMI or CABG and compared patient demographics, comorbidity, and risk-standardized mortality in specialty and general hospitals.


RESULTS
Specialty hospitals admitted a lower proportion of women and blacks and treated patients with less comorbid illness than general hospitals. Unadjusted in-hospital AMI mortality for Medicare enrollees in specialty and general hospitals was 6.1 and 10.1 percent (p<.0001) and for non-Medicare enrollees was 2.8 and 4.0 percent (p<.04). Unadjusted in-hospital CABG mortality for Medicare enrollees in specialty and general hospitals was 3.2 and 4.7 percent (p<.01) and for non-Medicare enrollees was 1.1 and 1.8 percent (p=.02). After adjusting for patient characteristics and hospital volume, risk-standardized in-hospital mortality for all AMI patients was 2.7 percent for specialty hospitals and 4.1 percent for general hospitals (p<.001) and for CABG was 1.5 percent for specialty hospitals and 2.0 percent for general hospitals (p=.07).


CONCLUSIONS
In-hospital mortality in specialty hospitals was lower than in general hospitals for AMI but similar for CABG. Our results suggest that specialty hospitals may offer significantly better outcomes for AMI but not CABG.
Cram
Peter
P
Division of General Medicine, University of Iowa Carver College of Medicine, Iowa City VA Medical Center, Mail Stop 152, Iowa City, IA, USA. peter-cram@uiowa.edu
Bayman
Levent
L
Popescu
Joanna
J
Vaughan-Sarrazin
Mary S
MS
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D019992:Databases as Topic; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006769:Hospitals, General / Q000592:standards / Q000706:statistics & numerical data*; D006782:Hospitals, Special / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D014481:United States / Q000453:epidemiology