Quality of Care for Acute Myocardial Infarction: Are the Gaps Between Rural and Urban Hospitals Closing

摘要

This study used detailed clinical information gathered by the Medicare Quality Improvement Organizations from the hospital records of 21,616 Medicare patients discharged from short-term, non-federal hospitals in 2000-2001 with a principal diagnosis of acute myocardial infarction. Weighting the data to a nationally representative sample (n = 159,305), we compared the quality of care between admissions to hospitals in or strongly associated with urban and three levels of rural location as defined by Rural-Urban Commuting Area (RUCA) codesurban (n = 119,011), large rural (n = 23,235), small rural (n = 13,932), and remote small rural (n = 3,127). Quality measures included receipt of aspirin within 24 hours before or after hospital arrival, aspirin prescription at discharge, beta blocker prescription at discharge, and angiotensin converting enzyme (ACE) inhibitor at discharge for those with left ventricular ejection fraction under 40%.