Is Coronary Angiography Underused by Poor and Uninsured Patients. Abstract,Appendix, Executive Summary and Final Report of Dissertation

摘要

Prior studies have documented significant geographic variations in the use ofhealth services as well as substantial levels of inappropriate use. Other studies have shown differences in the use of medical care and cardiac procedures in particular among ethnic groups, social classes and men and women. To date no studies have shown underuse of a medical or surgical procedure. This study is an investigation of the underuse of coronary angiography among poor and insured patients who receive medical care at Los Angeles County medical centers. Explicit criteria were used to measure underuse. These criteria were based on a set of indications for the clinical necessity of coronary angiography. Patients who underwent exercise stress testing and had a positive stress test at three Los Angeles County hospitals or at the private university hospital between January 1, 1990 and June 3, 1991 were eligible for inclusion in the study. Data were collected using medical record abstraction and follow up telephone interviews. Of the 352 patients who met necessary indications, 56 percent underwent coronary angiography within twelve months following the exercise stress test. A higher proportion of patients from the private hospital than from the county hospitals underwent necessary coronary angiography three months after the stress test