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March 12, 2001Archives of Internal Medicine

Urban-Rural Differences in the Quality of Care for Medicare Patients With Acute Myocardial Infarction

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Why the study?

Does hospital location (urban vs. rural) impact the quality of inpatient care for Medicare patients with acute myocardial infarction?

Population

2,521 Medicare patients aged 65 years and older who survived acute myocardial infarction and were discharged…

Comparison

Care in urban hospitals (n=12) vs Care in semirural and rural hospitals

Design

Cohort

Follow-up

in-hospital to discharge

Authors

KSKazim SheikhNational Patient Safety FoundationCBClaudia BullockCenters for Medicare and Medicaid Services

Discussion

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Implication

Rural-urban AMI medication gaps are hypothesis-generating; prospective studies needed to identify modifiable factors before practice change.

Structured PICO

Does hospital location (urban vs. rural) impact the quality of inpatient care for Medicare patients with acute myocardial infarction?

P
Population
2,521 Medicare patients aged 65 years and older who survived acute myocardial infarction (AMI) and were discharged alive from 119 acute care hospitals in Kansas during an 8-month period in 1994/1995.
I
Intervention
Care in urban hospitals (n=12)
C
Comparator
Care in semirural (n=31) and rural (n=76) hospitals
O
Outcome
Quality of care indicators including use of aspirin (during hospital stay and at discharge), administration of beta-blockers, intravenous (IV) nitroglycerin, heparin, and reperfusion by thrombolytic therapy or primary angioplasty

Rural hospitals provided relatively poorer quality of care for AMI patients compared to urban hospitals, highlighting a significant opportunity for quality improvement.

Cite This Study

Sheikh et al. (2001) studied this question.

synapsesocial.com/papers/6a871a31740e6cf4b5cf92dehttps://doi.org/10.1001/archinte.161.5.737

Topics

Dual antiplatelet therapy
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1ACC/AHA Guidelines for the Management of Patients With Acute Myocardial Infarction:Executive Summary1996 · 305 citations
  2. 2Geographic Variation in the Treatment of Acute Myocardial Infarction1999 · 331 citations
  3. 3The Association between Hospital Volume and Survival after Acute Myocardial Infarction in Elderly Patients1999 · 377 citations
  4. 4Regional Variation across the United States in the Management of Acute Myocardial Infarction1996 · 241 citations
  5. 5Aspirin in the Treatment of Acute Myocardial Infarction in Elderly Medicare Beneficiaries1995 · 186 citations