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Usual Source of Care and Outcomes Following Acute Myocardial Infarction |
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| Authors: | Erica S. Spatz MD MHS Sameer D. Sheth MD Kensey L. Gosch MS Mayur M. Desai PhD MPH John A. Spertus MD MPH Harlan M. Krumholz MD SM Joseph S. Ross MD MHS |
| Affiliation: | 1. Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA 10. Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale University School of Medicine/Yale-New Haven Hospital, One Church Street, Suite 200, New Haven, CT, 06510, USA 2. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA 3. Department of Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA 4. Department of Cardiology, Mid America Heart Institute of St. Luke’s Hospital, Kansas City, MO, USA 5. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA 6. Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA 7. Department of Cardiology, University of Missouri-Kansas City, Kansas City, MO, USA 8. Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA 9. Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA |
| Abstract: | BackgroundThe quality of the relationship between a patient and their usual source of care may impact outcomes, especially after an acute clinical event requiring regular follow-up.ObjectiveTo examine the association between the presence and strength of a usual source of care with mortality and readmission after hospitalization for acute myocardial infarction (AMI).DesignProspective Registry Evaluating Myocardial Infarction: Event and Recovery (PREMIER), an observational, 19-center study.PatientsAMI patients discharged between January 2003 and June 2004.Main MeasuresThe strength of the usual source of care was categorized as none, weak, or strong based upon the duration and familiarity of the relationship. Main outcome measures were readmissions and mortality at 6 months and 12 months post-AMI, examined in multivariable analysis adjusting for socio-demographic characteristics, access and barriers to care, financial status, baseline risk factors, and AMI severity.Key ResultsAmong 2,454 AMI patients, 441 (18.0 %) reported no usual source of care, whereas 247 (10.0 %) and 1,766 (72.0 %) reported weak and strong usual sources of care, respectively. When compared with a strong usual source of care, adults with no usual source of care had higher 6-month mortality rates [adjusted hazard ratio (aHR) = 3.15, 95 % CI, 1.79–5.52; p < 0.001] and 12-month mortality rates (aHR = 1.92, 95 % CI, 1.19–3.12; p = 0.01); adults with a weak usual source of care trended toward higher mortality at 6 months (aHR = 1.95, 95 % CI, 0.98–3.88; p = 0.06), but not 12 months (p = 0.23). We found no association between the usual source of care and readmissions.ConclusionsAdults with no or weak usual sources of care have an increased risk for mortality following AMI, but not for readmission.Electronic supplementary materialThe online version of this article (doi:10.1007/s11606-014-2794-0) contains supplementary material, which is available to authorized users.KEY WORDS: doctor and patient relationship, usual source of care, myocardial infarction |
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