Where do elderly veterans obtain care for acute myocardial infarction: Department of Veterans Affairs or Medicare?

摘要: Abstract OBJECTIVE: To examine Department of Veterans Affairs (VA) and Medicare hospitalizations for elderly veterans with acute myocardial infarction (AMI), their use cardiac procedures in both systems, patient mortality. DATA SOURCES: Merging inpatient discharge abstracts obtained from VA Patient Treatment Files (PTF) MedPAR Part A files. STUDY DESIGN: retrospective cohort study male 65 years or older who were prior users the medical system (veteran-users) initially admitted to a hospital primary diagnosis AMI at some time January 1, 1988 through December 31, 1990 (N = 25,312). We examined catheterization, coronary bypass surgery, percutaneous transluminal angioplasty 90 days after initial admission survival 30 days, one year. Other key measures included age, race, marital status, comorbidities, complications, utilization, availability technology admitting hospital. PRINCIPAL FINDINGS: More than half veteran-users (54 percent) hospitalized when they suffered an AMI. These index patients more likely receive catheterization (OR 1.24, 95% C.I. 1.17-1.32), surgery 2.01, 1.83-2.20), 2.56, 2.30-2.85) patients. Small proportions crossed over between systems care (VA 3.3%, 5.1%). Many hospitals obtain (27.6 (12.1 percent). Mortality was not significantly different versus hospitals. CONCLUSIONS: Dual-system utilization highlights need look evaluating access, costs, quality either systems. Policy changes that affect access may lead unpredictable results other.