Abstract 3476: The Impact of For-profit Hospital Status on the Care of Patients with NSTEMI: Results from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines) National Quality Improvement Initiative
Background: Concern has been expressed that for-profit hospitals may have financial incentives to selectively treat younger, relatively healthier or insured patients, withhold expensive procedures or treatments, and encourage shorter inpatient length of stays (LOS).
Methods: Using data from the CRUSADE initiative, we investigated whether hospital type influenced patient casemix, care, and/or outcomes among 145,357 patients with non-ST-segment elevation myocardial infarction (NSTEMI) treated between January 1, 2001, and December 31, 2005, at 532 US hospitals. Impact of for-profit hospital status on care and outcomes was analyzed overall and after adjustment for clinical factors using regression modeling.
Results: CRUSADE included 58 for-profit (n=11,658 patients) and 474 non-profit (n=133,699 patients) centers based on American Hospital Association reporting. Compared with non-profit hospitals, patients treated at for-profit hospitals were of similar age (mean 67.6 vs 67.3 years), sex (38.9% vs 39.3%), more often had HMO/private insurance (45.8% vs 43.6%), and were more likely to be non-white (25.2% vs 18.9%, p<0.001). For-profit hospital patients also had higher rates of prior diabetes mellitus, congestive heart failure, hypertension and renal insufficiency. For-profit hospitals were less likely to use acute or discharge beta-blockers, but all other guideline-indicated treatments were similar (Table⇓). In-hospital mortality rates and hospital LOS were likewise similar by hospital type.
Conclusions: Despite concerns, we found no evidence that for-profit hospitals selectively treat less sick patients, limit access to expensive therapies, or discharge NSTEMI patients more rapidly than non-profit centers.