Abstract P340: Outpatient Care Following Myocardial Infarction - The Atherosclerosis Risk in Communities (ARIC) Study
Background Patients with chronic cardiovascular disease conditions often require management by multiple healthcare providers. Evaluating the continuum of care for persons with cardiovascular disease will help inform policies to improve care and health outcomes. The aim of this study was to characterize patterns of care during the inpatient-outpatient transition and a two- year post-hospitalization period for Atherosclerosis Risk in Communities (ARIC) Study cohort members following incident myocardial infarction (MI).
Methods Data for ARIC cohort participants (n=15,738) were linked with CMS Medicare claims data for the years 1991-2009 (89.1% match). Analyses were conducted for ARIC cohort participants with adjudicated records of hospitalized incident MI events for the years 2000-2007 (n=788). Excluded from analyses were participants with continuous enrollment in Managed Care Organizations or without Part A and Part B CMS Medicare coverage (n=272), as well as participants with fatal MI at the time of hospitalization (n=169). We could not identify inpatient claims for 19 participants. The final study sample size was 328. Evaluation and Management codes were used to identify ambulatory visits. Time to first OP visit was analyzed using Kaplan-Meier methods to account for censoring at first all-cause hospitalreadmission.
Results We observed a median of 3 outpatient visits per study participant during 2 years following incident MI hospitalization. Of the 328 study participants, 220 had not had a re-hospitalization or had died at two weeks following discharge and 131 of those (59.5%) had an outpatient visit within two weeks. The median time to first outpatient visit following MI was 12 days (95% CI 11, 14). This time differed by race (white: 10 days (95% CI 9, 12); black: 21 days (95% CI 15, 30), p<0.01) and gender (female: 14 days (95% CI 12, 16); male 11 days (95%CI 9, 13) p=0.04). The median time to first outpatient visit was independent of MI severity. For 131 out of 204 study participants for whom we were able to identify healthcare providers, their first outpatient visit following MI was to a primary care provider (general internal medicine, family medicine, or nurse practitioner). Median time to first primary care visit was 16 days (95%CI 14, 20), whereas median time to first cardiology visit was 64 days (95% CI 48, 98). The above patterns of care following MI did not differ appreciably by diabetes or hypertension status.
Conclusions Our results suggest low compliance with ACC/AHA guidelines which recommend that follow-up care for MI occur within two to six weeks following discharge. Quality improvement efforts aimed at decreasing time to fist outpatient visit following MI should target women and minorities.
- © 2013 by American Heart Association, Inc.