Usual Source of Care and Outcomes Following Acute Myocardial Infarction

Spatz, Erica S.; Sheth, Sameer D.; Gosch, Kensey; Desai, Mayur M.; Spertus, John A.; Krumholz, Harlan M.; Ross, Joseph S.

doi:10.1007/s11606-014-2794-0

Cited by 16 publications

(15 citation statements)

References 21 publications

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“…Once outcomes data become available for a 3‐year post‐HRRP implementation period, the impact of this combined approach can be assessed. Second, because adherence to many evidence‐based process measures for these conditions (ie, aspirin use in AMI) is already high, there may be a “ceiling effect” present that obviates the need for further hospital financial investment to optimize delivery of best practices . Third, hospitals themselves may contribute little to variation in mortality and readmission risk.…”

Section: Discussionmentioning

confidence: 99%

Relationship between hospital financial performance and publicly reported outcomes

Nguyen

Halm

Makam

2016

Journal of Hospital Medicine

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Background Hospitals that have robust financial performance may have improved publicly reported outcomes. Objectives To assess the relationship between hospital financial performance and publicly reported outcomes of care, and to assess whether improved outcome metrics affect subsequent hospital financial performance. Design Observational cohort study. Setting And Patients Hospital financial data from the Office of Statewide Health Planning and Development in California in 2008 and 2012 were linked to data from the Centers for Medicare and Medicaid Services Hospital Compare website. Measurements Hospital financial performance was measured by net revenue by operations, operating margin, and total margin. Outcomes were 30-day risk-standardized mortality and readmission rates for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PNA). Results Among 279 hospitals, there was no consistent relationship between measures of financial performance in 2008 and publicly reported outcomes from 2008 to 2011 for AMI and PNA. However, improved hospital financial performance (by any of the 3 measures) was associated with a modest increase in CHF mortality rates (ie, 0.26% increase in CHF mortality rate for every 10% increase in operating margin [95% confidence interval: 0.07%-0.45%]). Conversely, there were no significant associations between outcomes from 2008 to 2011 and subsequent financial performance in 2012 (P > 0.05 for all). Conclusions Robust financial performance is not associated with improved publicly reported outcomes for AMI, CHF, and PNA. Financial incentives in addition to public reporting, such as readmissions penalties, may help motivate hospitals with robust financial performance to further improve publicly reported outcomes. Reassuringly, improved mortality and readmission rates do not necessarily lead to loss of revenue.

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Section: Discussionmentioning

confidence: 99%

Relationship between hospital financial performance and publicly reported outcomes

Nguyen

Halm

Makam

2016

Journal of Hospital Medicine

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“…For instance, having a usual source of care is a more robust predictor than insurance status for healthcare utilization, cardiovascular disease screening, or receipt of information from healthcare providers about necessary lifestyle changes and inadequate hypertension management [3,4]. For individuals who have experienced an acute myocardial infarction, lack of a usual source of care is associated with higher mortality rates compared to those reporting stronger relationships with a regular physician [5].…”

Section: Introductionmentioning

confidence: 99%

Unfavorable perceived neighborhood environment associates with less routine healthcare utilization: Data from the Dallas Heart Study

et al. 2020

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Neighborhood environment perception (NEP) has been associated with health outcomes. However, little is known about how NEP relates to routine healthcare utilization. This study investigated the relationship between NEP and independent subfactors with healthcare utilization behavior, as measured by self-reported (1) usual source of healthcare and (2) time since last routine healthcare checkup. We used cross-sectional data from the Dallas Heart Study, which features a diverse, probability-based sample of Dallas County residents ages 18 to 65. We used logistic regression modeling to examine the association of self-reported NEP and routine healthcare utilization. NEP was assessed via a questionnaire exploring residents' neighborhood perceptions, including violence, the physical environment, and social cohesion. Routine healthcare utilization was assessed via self-reported responses regarding usual source of care and time since last routine healthcare checkup. The analytic sample (N = 1706) was 58% black, 27% white, 15% Hispanic, 42% male, and had a mean age of 51 (SD = 10.3). Analysis of NEP by tertile demonstrated that younger age, lower income, and lower education were associated with unfavorable overall NEP (p trend <0.05 for each). After adjustment for potential confounders, including neighborhood deprivation, health insurance, disease burden and psychosocial factors, we found that individuals with more unfavorable perception of their physical environment were more likely to report lack of a usual source of care (p = 0.013). Individuals with more unfavorable perception of the neighborhood physical environment or greater neighborhood violence reported longer time periods since last routine visit (p = 0.001, p = 0.034 respectively). There was no relationship between perceived social cohesion and healthcare utilization. Using a multi-ethnic cohort, we found that NEP significantly associates with report of a usual source of care and time since last routine checkup. Our findings suggest that public health professionals should prioritize improving NEP since it may act as barrier to routine preventive healthcare and ideal health outcomes.

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“…), although the relationship between having a USC and hospital admissions remains indeterminate (Spatz et al. ; Coller et al. ).…”

mentioning

confidence: 99%

“…When patients have a trusted guide, they change their care-seeking behavior, which has positive effects on the health care system. For example, studies have found that those with a USC rely less on emergency departments (EDs; Villani and Mortensen 2013; Liaw et al 2014;Janke et al 2015), although the relationship between having a USC and hospital admissions remains indeterminate (Spatz et al 2014;Coller et al 2015). While pairing a USC with insurance synergistically increases access, having a USC has been shown to be the more powerful predictor (Bindman et al 1996;Sox et al 1998;Dovey et al 2003;Fryer et al 2003;Bliss et al 2004).…”

mentioning

confidence: 99%

Trends in the Types of Usual Sources of Care: A Shift from People to Places or Nothing at All

Liaw

Jetty

Petterson

et al. 2017

Health Services Research

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Usual Source of Care and Outcomes Following Acute Myocardial Infarction

Cited by 16 publications

References 21 publications

Relationship between hospital financial performance and publicly reported outcomes

Relationship between hospital financial performance and publicly reported outcomes

Unfavorable perceived neighborhood environment associates with less routine healthcare utilization: Data from the Dallas Heart Study

Trends in the Types of Usual Sources of Care: A Shift from People to Places or Nothing at All

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