Geographic Variation in Cardiac Rehabilitation Participation in Medicare and Veterans Affairs Populations Opportunity for Improvement
Geographic Variation in Cardiac Rehabilitation Participation in Medicare and Veterans Affairs Populations Opportunity for Improvement
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DOI：
10.1161/circulationaha.117.029471
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发表时间：
2018-05-01
期刊：
影响因子：
37.8
通讯作者：
Whooley, Mary A.
中科院分区：
文献类型：
--
作者：
Beatty, Alexis L.;Truong, Michael;Whooley, Mary A.
背景：心肌梗死、经皮冠状动脉介入治疗或冠状动脉搭桥术后强烈推荐心脏康复，但历史上一直未得到充分利用。我们试图评估全美心脏康复参与的差异。方法：从退伍军人事务部(VA)医疗保健系统的管理数据和5%的医疗保险样本中，我们使用国际疾病分类，第9版代码来确定从2007年到2011年因心肌梗死、经皮冠状动脉介入治疗或冠状动脉搭桥手术而住院的患者。剔除在住院后12个月内死亡的患者=1例因心脏康复就诊的患者。结果：总体上，联邦医疗保险和退伍军人管理局的心脏康复参与率分别为16.3%(23403/143756)和10.3%(9123/88826)。然而，各州的参与率差异很大，从3.2%到41.8%的医疗保险和1.2%到47.6%的退伍军人管理局。在两个种群中都观察到了相似的区域变异。西北中部地区(爱荷华州、堪萨斯州、明尼苏达州、密苏里州、内布拉斯加州、北达科他州和南达科他州)的患者参与率最高，而太平洋地区(阿拉斯加、加利福尼亚州、夏威夷、俄勒冈州和华盛顿州)的患者在联邦医疗保险(33.7%对10.6%)和退伍军人管理局(16.6%对5.1%)人口中的参与率最低。医院水平也存在显著差异，参与医疗保险的比例从3%到75%不等，参与退伍军人管理局的比例从1%到43%不等。结论：总体上，医疗保险和退伍军人管理局的心脏康复参与率仍然较低。然而，存在着非常相似的地区差异，一些地区和医院在两个人群中实现了很高的参与率。这提供了一个机会，从业绩较好的医院和地区确定可用于改善业绩较差的医院和地区的心脏康复参与情况的最佳做法。
BACKGROUND: Cardiac rehabilitation is strongly recommended after myocardial infarction, percutaneous coronary intervention, or coronary artery bypass surgery, but it is historically underused. We sought to evaluate variation in cardiac rehabilitation participation across the United States.METHODS: From administrative data from the Veterans Affairs (VA) healthcare system and a 5% Medicare sample, we used International Classification of Diseases, 9th Revision codes to identify patients hospitalized for myocardial infarction, percutaneous coronary intervention, or coronary artery bypass surgery from 2007 to 2011. After excluding patients who died in = 1 outpatient visits for cardiac rehabilitation during the 12 months after hospitalization. We estimated adjusted and standardized rates of participation in cardiac rehabilitation by state using hierarchical logistic regression models.RESULTS: Overall, participation in cardiac rehabilitation was 16.3% (23403/143756) in Medicare and 10.3% (9123/88826) in VA. However, participation rates varied widely across states, ranging from 3.2% to 41.8% in Medicare and 1.2% to 47.6% in VA. Similar regional variation was observed in both populations. Patients in the West North Central region (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota) had the highest participation, whereas those in the Pacific region (Alaska, California, Hawaii, Oregon, and Washington) had the lowest participation in both Medicare (33.7% versus 10.6%) and VA (16.6% versus 5.1%) populations. Significant hospital-level variation was also present, with participation ranging from 3% to 75% in Medicare and 1% to 43% in VA.CONCLUSIONS: Cardiac rehabilitation participation remains low overall in both Medicare and VA populations. However, remarkably similar regional variation exists, with some regions and hospitals achieving high rates of participation in both populations. This provides an opportunity to identify best practices from higher performing hospitals and regions that could be used to improve cardiac rehabilitation participation in lower performing hospitals and regions.