PMID- 21886026
OWN - NLM
STAT- MEDLINE
DCOM- 20111027
LR  - 20110902
IS  - 1541-8243 (Electronic)
IS  - 0038-4348 (Linking)
VI  - 104
IP  - 6
DP  - 2011 Jun
TI  - Geographic variations in percutaneous coronary interventions and coronary artery 
      bypass graft surgery among Tennessee elders.
PG  - 389-96
LID - 10.1097/SMJ.0b013e3182186fdc [doi]
AB  - OBJECTIVES: Coronary heart disease often presents with ST segment elevation acute 
      myocardial infarction (STEMI). The American College of Cardiology/American Heart 
      Association guidelines stress prompt reperfusion for STEMI. Examining geographic 
      variations in treatment with PPCI (percutaneous primary coronary intervention) 
      and CABG (coronary artery bypass graft) among metropolitan, micropolitan and 
      non-micropolitan rural residents provides a descriptive basis for generating 
      hypotheses concerning place and receipt of guidelines-based treatment. METHODS: 
      Using ICD-9 codes for STEMI and excluding beneficiaries with pre-existing MI in 
      claims data, yielded a subset of 18,775 Tennessee Medicare beneficiaries 
      experiencing STEMI from 1996 to 2002. The outcome variable is type of treatment, 
      i.e., in accord (PPCI or CABG present) or not in accord (PPCI or CABG absent) 
      with guidelines. Independent variables include type county residence, hospital 
      volume, race, gender, and age. Analyses include cross-tabulation and logistic 
      regression, estimating separate models by age and type of MI. RESULTS: 
      Micropolitan residents with STEMI have the lowest rates for PPCI (18.8%) versus 
      28.1% percent for metropolitan and 24.2% for non-micropolitan rural residents. 
      CABG follows similar patterns at lower overall rates. Treatment at a heart center 
      with high volume PPCI mediated the relationship between the likelihood of PPCI 
      and place. CONCLUSION: The correspondence between metropolitan and rural 
      utilization suggests that access to a full range of treatment options and 
      likelihood of "best practice" care is not dependent on metropolitan residence. 
      This presents the possibility that with some policy changes, e.g., centralization 
      of emergency heart care, the same may ultimately be true for micropolitan 
      residents.
FAU - Kilbourne, Barbara J
AU  - Kilbourne BJ
AD  - Department of Family, Meharry Medical College, Nashville, TN, USA. 
      bkilbourne@mmc.edu
FAU - Levine, Robert S
AU  - Levine RS
FAU - Lambert, Warren
AU  - Lambert W
FAU - Brown, Dustin
AU  - Brown D
FAU - Friesinger, Gottlieb 2nd
AU  - Friesinger G 2nd
FAU - Hennekens, Charles H
AU  - Hennekens CH
LA  - eng
GR  - 2P20MD0000516-O5A1/MD/NIMHD NIH HHS/United States
GR  - R24 HS014767-01/HS/AHRQ HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - South Med J
JT  - Southern medical journal
JID - 0404522
SB  - IM
MH  - Aged
MH  - Angioplasty, Balloon, Coronary/*statistics & numerical data
MH  - Coronary Artery Bypass/*statistics & numerical data
MH  - Coronary Disease/surgery/*therapy
MH  - Guideline Adherence
MH  - Health Services Needs and Demand/*statistics & numerical data
MH  - Humans
MH  - Logistic Models
MH  - Myocardial Infarction/surgery/therapy
MH  - Practice Guidelines as Topic
MH  - Rural Health Services/*statistics & numerical data
MH  - Tennessee
MH  - Urban Health Services/*statistics & numerical data
EDAT- 2011/09/03 06:00
MHDA- 2011/10/28 06:00
CRDT- 2011/09/03 06:00
PHST- 2011/09/03 06:00 [entrez]
PHST- 2011/09/03 06:00 [pubmed]
PHST- 2011/10/28 06:00 [medline]
AID - 00007611-201106000-00003 [pii]
AID - 10.1097/SMJ.0b013e3182186fdc [doi]
PST - ppublish
SO  - South Med J. 2011 Jun;104(6):389-96. doi: 10.1097/SMJ.0b013e3182186fdc.