title: Usual source of care and outcomes following acute myocardial infarction.
abstract: BACKGROUND
  The quality of the relationship between a patient and their usual source of care may impact outcomes, especially after an acute clinical event requiring regular follow-up.
  
  
  OBJECTIVE
  To examine the association between the presence and strength of a usual source of care with mortality and readmission after hospitalization for acute myocardial infarction (AMI).
  
  
  METHODS
  Prospective Registry Evaluating Myocardial Infarction: Event and Recovery (PREMIER), an observational, 19-center study.
  
  
  METHODS
  AMI patients discharged between January 2003 and June 2004.
  
  
  METHODS
  The strength of the usual source of care was categorized as none, weak, or strong based upon the duration and familiarity of the relationship. Main outcome measures were readmissions and mortality at 6 months and 12 months post-AMI, examined in multivariable analysis adjusting for socio-demographic characteristics, access and barriers to care, financial status, baseline risk factors, and AMI severity.
  
  
  RESULTS
  Among 2,454 AMI patients, 441 (18.0 %) reported no usual source of care, whereas 247 (10.0 %) and 1,766 (72.0 %) reported weak and strong usual sources of care, respectively. When compared with a strong usual source of care, adults with no usual source of care had higher 6-month mortality rates [adjusted hazard ratio (aHR) = 3.15, 95 % CI, 1.79-5.52; p < 0.001] and 12-month mortality rates (aHR = 1.92, 95 % CI, 1.19-3.12; p = 0.01); adults with a weak usual source of care trended toward higher mortality at 6 months (aHR = 1.95, 95 % CI, 0.98-3.88; p = 0.06), but not 12 months (p = 0.23). We found no association between the usual source of care and readmissions.
  
  
  CONCLUSIONS
  Adults with no or weak usual sources of care have an increased risk for mortality following AMI, but not for readmission.
authors.affiliation: Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA, Erica.spatz@yale.edu.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Spatz
authors.forename: Sameer D
authors.initials: SD
authors.lastname: Sheth
authors.forename: Kensey L
authors.initials: KL
authors.lastname: Gosch
authors.forename: Mayur M
authors.initials: MM
authors.lastname: Desai
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
mesh_terms: D000328:Adult; D000359:Aftercare / Q000379:methods / Q000458:organization & administration; D000368:Aged; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000401:mortality / Q000628:therapy; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology