Survival and spending
Overall, the percentage of heart attack patients who survive the first six months after their attack has gone up since 1999 -- from 73 percent to 78.5 percent. Americans, in fact, are much more likely to survive the immediate aftermath of a heart attack than people in other developed countries, according to the World Health Organization.
Spending on the care of heart attack patients has gone up in that time, too -- nearly 14 percent across the 15 years of the study, with a plateau in costs in the last six years.
But these across-the-board numbers mask huge variation in both mortality and dollars depending on which hospital patients were treated at, and what kind of care they received.
For instance, Medicare spending rose 44 percent in 15 years for one group of hospitals at the high end of spending growth. But Medicare heart attack spending dropped nearly 19 percent for those at the low end.
Early PCI: Cost-effective but varying use
Hospitals that focused on getting heart attack patients diagnosed and onto the angioplasty table within the first 24 hours after their first symptoms achieved the biggest gains in survival. As a whole, these hospitals actually lowered the average cost for a patient's post-heart attack care measured over six months, the analysis shows.
The percentage of patients getting this procedure done rapidly -- called early percutaneous coronary intervention or PCI -- doubled in the time period of the study. And hospitals that increased their use of early PCI the most actually had lower spending on several types of post-hospital care for their patients, including nursing home and in-home care.
"We also find that patients at high-volume hospitals benefit the most from early stenting treatments by interventional cardiologists," says co-author Jessica Van Parys, Ph.D. of Hunter College. "This finding is most likely because physician and nursing staff learn over time what works best for their heart attack patients."
Meanwhile, when looking across all hospitals, spending on skilled nursing facility care and home care doubled during the study period, and spending on outpatient care tripled.
But patients who saw doctors in outpatient visits more often after their heart attack were no less likely to die in those first six months, on average.
The analysis also reveals a lot of opportunity to improve the care heart attack patients get in the first six months, and the value that the nation gets from the dollars spent on it.
Part of that effort could include providing hospitals and individual providers regular reports on their patterns of care their patients are receiving across all health care settings, and the related costs. This would also offer a chance to inform providers and administrators about the evidence behind -- or against -- certain practices.
"If we don't provide feedback they won't know where to improve," says Likosky. "We need to develop and implement models for evaluating ways to address both quality and spending. Better involvement of frontline providers in designing and implementing change is crucial, especially if we seek to reduce variability in quality and spending. Clinical providers are likely best suited to both know what works, and why."
Likosky and colleagues note that in Michigan and northern New England, cardiac care providers and hospitals have come together across their regions to pool data and feed reports back to each hospital and provider to drive improvement efforts. A similar effort for heart attack care nationwide could start with looking at what differentiates hospitals from one another, and what the low-cost/low-mortality hospitals can teach their peers.Cannot Find low price Best pill? Low Price buying modafinil online legal us, Free Bonus Pills buying modafinil online legal us and Low Price Low Cost. Pill Shop, Cheap Prices. Free samples for all orders.
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