title: Payment source, quality of care, and outcomes in patients hospitalized with heart failure.
abstract: OBJECTIVE
  The aim of this study was to analyze the relationship between payment source and quality of care and outcomes in heart failure (HF).
  
  
  BACKGROUND
  HF is a major cause of morbidity and mortality. There is a lack of studies assessing the association of payment source with HF quality of care and outcomes.
  
  
  METHODS
  A total of 99,508 HF admissions from 244 sites between January 2005 and September 2009 were analyzed. Patients were grouped on the basis of payer status (private/health maintenance organization, no insurance, Medicare, or Medicaid) with private/health maintenance organization as the reference group.
  
  
  RESULTS
  The no-insurance group was less likely to receive evidence-based beta-blockers (adjusted odds ratio [OR]: 0.73; 95% confidence interval [CI]: 0.62 to 0.86), implantable cardioverter-defibrillator (OR: 0.59; 95% CI: 0.50 to 0.70), or anticoagulation for atrial fibrillation (OR: 0.73; 95% CI: 0.61 to 0.87). Similarly, the Medicaid group was less likely to receive evidence-based beta-blockers (OR: 0.86; 95% CI: 0.78 to 0.95) or implantable cardioverter-defibrillators (OR: 0.86; 95% CI: 0.78 to 0.96). Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and beta-blockers were prescribed less frequently in the Medicare group (OR: 0.89; 95% CI: 0.81 to 0.98). The Medicare, Medicaid, and no-insurance groups had longer hospital stays. Higher adjusted rates of in-hospital mortality were seen in patients with Medicaid (OR: 1.22; 95% CI: 1.06 to 1.41) and in patients with reduced systolic function with no insurance.
  
  
  CONCLUSIONS
  Decreased quality of care and outcomes for patients with HF were observed in the no-insurance, Medicaid, and Medicare groups compared with the private/health maintenance organization group.
authors.affiliation: University of Chicago Pritzker School of Medicine, Chicago, IL, USA. doctorjrk@gmail.com
authors.forename: John R
authors.initials: JR
authors.lastname: Kapoor
authors.forename: Roger
authors.initials: R
authors.lastname: Kapoor
authors.forename: Anne S
authors.initials: AS
authors.lastname: Hellkamp
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000191:economics* / Q000628:therapy; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000592:standards; D008297:Male; D017057:Medically Uninsured; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care / Q000191:economics* / Q000592:standards; D012042:Registries; D016896:Treatment Outcome; D014481:United States