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CLINICAL RESEARCH: ACUTE CORONARY SYNDROME

The Impact of For-Profit Hospital Status on the Care and Outcomes of Patients With Non–ST-Segment Elevation Myocardial Infarction

Results From the CRUSADE Initiative

Bimal R. Shah, MD^_*,_*, Seth W. Glickman, MD, MBA^_*, Li Liang, PhD^_*, W. Brian Gibler, MD, E. Magnus Ohman, MD^_*, Charles V. Pollack, Jr, MD, MA, Matthew T. Roe, MD, MHS^_* and Eric D. Peterson, MD, MPH^_*

^_* Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
University of Cincinnati College of Medicine, Cincinnati, Ohio
Pennsylvania Hospital, Philadelphia, Pennsylvania.

Manuscript received February 5, 2007; revised manuscript received June 21, 2007, accepted July 9, 2007.

^_* Reprint requests and correspondence: Dr. Bimal R. Shah, Duke University Medical Center, Box 31199, Durham, North Carolina 27710. (Email: bimal.shah{at}duke.edu).

Objectives: We sought to determine whether for-profit status influenced hospitals’ care or outcomes among non–ST-segment elevation myocardial infarction (NSTEMI) patients.

Background: While for-profit hospitals potentially have financial incentives to selectively care for younger, healthier patients, perform highly reimbursed procedures, reduce costs by limiting access to expensive medications, and encourage shorter in-patient length of stay, there are limited data available to investigate these issues objectively.

Methods: Using data from the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association guidelines) Initiative, we investigated whether for-profit status influenced hospitals’ patient case mix, care, or outcomes among 145,357 patients with NSTEMI treated between January 1, 2001, and December 31, 2005, at 532 U.S. hospitals. Impact of for-profit status on care and outcomes was analyzed overall and after adjustment for clinical and facility factors using regression modeling.

Results: Patients (n = 11,658) treated at 58 for-profit hospitals were of similar age and gender, but were more likely to be nonwhite (black, Asian, Hispanic, and other) and have health maintenance organization/private insurance, diabetes mellitus, congestive heart failure, hypertension, and renal insufficiency compared with 133,699 patients treated at 474 nonprofit hospitals. For-profit hospitals were less likely to use discharge beta-blockers, but all other treatments were similar including the use of interventional procedures (cardiac catheterization and revascularization procedures) compared with nonprofit centers. In-hospital length of stay and mortality were also similar by hospital type.

Conclusions: We found no evidence that for-profit hospitals selectively treat less sick patients, provide less evidence-based care, limit in-hospital stays, or have patients with worse acute outcomes than nonprofit centers.

Abbreviations and Acronyms   ACC = American College of Cardiology   ACS = acute coronary syndrome   AHA = American Heart Association   CABG = coronary artery bypass graft   CHF = congestive heart failure   HMO = health maintenance organization   LOS = length of stay   NSTEMI = non–ST-segment elevation myocardial infarction   PCI = percutaneous coronary intervention   STEMI = ST-segment elevation myocardial infarction

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