Mental illness, access to hospitals with invasive cardiac services, and receipt of cardiac procedures by Medicare acute myocardial infarction patients.
Mental illness, access to hospitals with invasive cardiac services, and receipt of cardiac procedures by Medicare acute myocardial infarction patients.
复制标题
医疗保险急性心肌梗塞患者患有精神疾病、接受侵入性心脏服务的医院以及接受心脏手术。
DOI：
10.1111/1475-6773.12010
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发表时间：
2013
影响因子：
3.4
通讯作者：
Mukamel,DanaB
中科院分区：
文献类型：
--
作者：
Li,Yue;Glance,LaurentG;Lyness,JeffreyM;Cram,Peter;Cai,Xueya;Mukamel,DanaB
目的老年冠心病患者如果同时患有精神病，他们获得适当的医疗和外科服务的机会就会减少。这项研究确定了在全国范围内，有无合并精神疾病的急性心肌梗死(AMI)患者在获得提供现场侵入性心脏手术的医院的机会方面是否存在差异，以及对后续程序使用的影响。方法回顾分析2007年1月至9月首次入院的急性心肌梗死患者的医疗保险申请。医院服务可获得性来自年度调查数据。Logistic回归分析精神疾病与任何有创心脏服务(诊断性导管术、冠状动脉成形术或搭桥手术)入院以及入院后护理模式和结果的关系。结果82%的精神病急性心肌梗死患者(n=28888)与87%的其他急性心肌梗死患者(n=73895)最初住进有侵入性心脏设施的医院[调整后的优势比(OR)=100.81，p<；001.001]。这些医院的入院与入院后90天内程序使用率的总体较高以及30天再入院和死亡率的改善有关。然而，不考虑入院医院的现场服务可用性，精神病患者接受侵入性手术的可能性是后者的一半(调整后的OR约为0.5，p<；等.001)。结论在医疗保险急性心肌梗死患者中，合并精神疾病的患者不太可能进入有现场侵入性心脏服务的医院。精神疾病与每一类入院医院(是否有现场侵入性心脏服务)中心脏手术使用的减少有关。
ObjectiveOlder persons with coronary heart disease have reduced access to appropriate medical and surgical services if they are also mentally ill. This study determined whether difference exists in access to hospitals that provide on‐site invasive cardiac procedures among a national cohort of Medicare acute myocardial infarction (AMI) patients with and without comorbid mental illness, and its implications for subsequent procedure use.MethodsRetrospective analyses of Medicare claims for initial AMI admissions between January and September 2007. Hospital service availability was obtained from annual survey data. Logistic regression estimated the associations of mental illness with admission to hospitals with any invasive cardiac services (diagnostic catheterization, coronary angioplasty, or bypass surgery) and post‐admission care patterns and outcomes.ResultsEighty‐two percent of mentally ill AMI patients (n= 28,888) versus 87 percent of other AMI patients (n= 73,895) were initially admitted to hospitals with invasive cardiac facilities [adjusted odds ratio (OR) = 0.81,p< .001]. Admission to such hospitals was associated with overall higher rate of procedure use within 90 days of admission and improved 30‐days readmission and mortality rates. However, irrespective of on‐site service availability of the admitting hospital, mentally ill patients were one half as likely to receive invasive procedures (adjusted OR approximately 0.5,p< .001).ConclusionsAmong Medicare patients with AMI, those with comorbid mental illness were less likely to be admitted to hospitals with on‐site invasive cardiac services. Mental illness was associated with reduced cardiac procedure use within each type of admitting hospitals (with on‐site invasive cardiac services or not).