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Payment source, quality of care, and outcomes in patients hospitalized with heart failure.

Publication ,  Journal Article
Kapoor, JR; Kapoor, R; Hellkamp, AS; Hernandez, AF; Heidenreich, PA; Fonarow, GC
Published in: J Am Coll Cardiol
September 27, 2011

OBJECTIVES: 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.

Duke Scholars

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

September 27, 2011

Volume

58

Issue

14

Start / End Page

1465 / 1471

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Registries
  • Quality of Health Care
  • Prospective Studies
  • Middle Aged
  • Medicare
  • Medically Uninsured
  • Male
  • Insurance, Health, Reimbursement
 

Citation

APA
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ICMJE
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Kapoor, J. R., Kapoor, R., Hellkamp, A. S., Hernandez, A. F., Heidenreich, P. A., & Fonarow, G. C. (2011). Payment source, quality of care, and outcomes in patients hospitalized with heart failure. J Am Coll Cardiol, 58(14), 1465–1471. https://doi.org/10.1016/j.jacc.2011.06.034
Kapoor, John R., Roger Kapoor, Anne S. Hellkamp, Adrian F. Hernandez, Paul A. Heidenreich, and Gregg C. Fonarow. “Payment source, quality of care, and outcomes in patients hospitalized with heart failure.J Am Coll Cardiol 58, no. 14 (September 27, 2011): 1465–71. https://doi.org/10.1016/j.jacc.2011.06.034.
Kapoor JR, Kapoor R, Hellkamp AS, Hernandez AF, Heidenreich PA, Fonarow GC. Payment source, quality of care, and outcomes in patients hospitalized with heart failure. J Am Coll Cardiol. 2011 Sep 27;58(14):1465–71.
Kapoor, John R., et al. “Payment source, quality of care, and outcomes in patients hospitalized with heart failure.J Am Coll Cardiol, vol. 58, no. 14, Sept. 2011, pp. 1465–71. Pubmed, doi:10.1016/j.jacc.2011.06.034.
Kapoor JR, Kapoor R, Hellkamp AS, Hernandez AF, Heidenreich PA, Fonarow GC. Payment source, quality of care, and outcomes in patients hospitalized with heart failure. J Am Coll Cardiol. 2011 Sep 27;58(14):1465–1471.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

September 27, 2011

Volume

58

Issue

14

Start / End Page

1465 / 1471

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Registries
  • Quality of Health Care
  • Prospective Studies
  • Middle Aged
  • Medicare
  • Medically Uninsured
  • Male
  • Insurance, Health, Reimbursement