Abstract 12269: Health Care Insurance Status and Cardiac Performance Measure Compliance: Insights from the ACC's NCDR PINNACLE Registry
Background: While lack of health insurance affects access to outpatient care, the association of health insurance and receiving evidenced-based treatment among outpatients with coronary artery disease (CAD) and heart failure (HF) in not known.
Methods: Within the ACC's Practice Innovation And Clinical Excellence (PINNACLE) program, we identified 136,204 cardiac patients with an index outpatient visit from over 26 US practices between January 1, 2009 and December 31, 2009. Using modified Poisson regression, we compared compliance rates for 6 ACC/AHA performance measures related to CAD and HF medications by patients' insurance status (insured vs. not insured).
Results: Of 136,204 patients, 8278 (6%) patients were uninsured and 127,695 (94%) patients were insured. Uninsured patients with CAD were 4%, 7%, and 15% less likely to receive treatment with B-blocker, lipid lowering, and anti-platelet therapy, respectively, than insured patients (Table). However, much of the disparity in lipid lowering and anti-platelet therapy in CAD patients was explained by controlling for the site and physician providing care (Table). For example, whereas uninsured patients were 15% less likely to receive antiplatelet therapy for CAD (RR=0.85; 95% CI 0.83–0.88), there was no difference in antiplatelet therapy after adjustment for site and physician (RR=1.00; 95% CI 0.97–1.03). In contrast, there were no differences by insurance status for treatment with ACE-I/ARB in CAD or HF or with B-blocker therapy in HF.
Conclusions: Within this national, outpatient cardiac registry, uninsured patients were less likely to receive evidence-based medication treatment for CAD, but not for HF. These disparities were largely explained by the site and physician providing care. Efforts to reduce treatment differences by insurance status among cardiac outpatients will need to focus on improving rates of evidence-based treatment at sites with high proportions of uninsured patients.
- © 2010 by American Heart Association, Inc.