title: Underutilization of percutaneous coronary intervention for ST-elevation myocardial infarction in medicaid patients relative to private insurance patients.
abstract: OBJECTIVE
  To determine whether disparities in access to invasive cardiac procedures still exist for Medicaid patients, given how old earlier studies are and given changes in the interim in appropriateness guidelines.
  
  
  METHODS
  A total of 5,022 Medicaid and private insurance patients in New York from January 1, 2008 through December 31, 2009 under age 65 with ST-elevation myocardial infarction (STEMI) were compared with regard to their access to percutaneous coronary interventions (PCI) before and after controlling for numerous patient characteristics and other important factors.
  
  
  RESULTS
  Medicaid patients were significantly less likely to be admitted initially to a hospital certified to perform PCI (90.4% vs. 94.3%, P < 0.001). Also, Medicaid patients were found to be significantly less likely to undergo PCI than other patients (adjusted odds ratio [AOR] = 0.81, 95% CI 0.66, 0.98, P = 0.03). When the probability of each hospital performing PCI for STEMI patients was controlled for, Medicaid patients were still less likely to undergo PCI after controlling for other risk factors (AOR = 0.80, 95% CI 0.65, 0.99, P = 0.04).
  
  
  CONCLUSIONS
  Medicaid STEMI patients are significantly less likely to undergo PCI within the same day of admission as private pay patients even after adjusting for patient characteristics related to receiving PCI, and the strength of this relationship is not diminished when controlling for whether the admitting hospital has approval to perform PCI or controlling for the tendency of the admitting hospital to treat STEMI with PCI.
authors: School of Public Health, University at Albany, Albany, New York.
authors: Edward L
authors: EL
authors: Hannan
authors: Ye
authors: Y
authors: Zhong
authors: Gary
authors: G
authors: Walford
authors: Alice K
authors: AK
authors: Jacobs
authors: Ferdinand J
authors: FJ
authors: Venditti
authors: Nicholas J
authors: NJ
authors: Stamato
authors: David R
authors: DR
authors: Holmes
authors: Samin
authors: S
authors: Sharma
authors: Foster
authors: F
authors: Gesten
authors: Spencer B
authors: SB
authors: King
mesh_terms: D000368:Aged; D005260:Female; D017408:Guidelines as Topic; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D009518:New York; D062645:Percutaneous Coronary Intervention; D014481:United States