Clinical investigations: congestive heart failureAssociation of consultation between generalists and cardiologists with quality and outcomes of heart failure care☆
Section snippets
Subjects
We studied Medicare beneficiaries, 65 years and older, discharged in 1994, with a principal discharge diagnosis of HF from 11 Alabama hospitals. This study is a secondary analysis of the baseline dataset of a HF quality improvement project conducted by the Alabama Quality Assurance Foundation (AQAF), the peer review organization for Alabama. The details of the study methodology and subject selection criteria have been described elsewhere.20 In brief, with Medicare claims data for index
Patient characteristics
Subjects (N = 1075) had a mean (± SD) age of 79 (± 7.5) years, 60% were women, and 18% were African American. Solo generalists cared for 588 patients (55%), solo cardiologists cared for 145 patients (13%), and 342 patients (32%) received consultative care. A total of 883 patients were eligible for an LVF evaluation, and 433 patients (49%) received an LVF evaluation during the index hospitalization. A total of 619 patients were eligible for ACE inhibitor therapy, and 363 patients (59%) were
Mortality and readmission
The overall 90-day mortality rate was 22%, and the 90-day readmission rate among patients who were discharged alive (n = 988) was 15%. The care category was not associated with mortality (Table V). However, compared with patients cared for by generalists, patients cared for by consultation had lower odds of having a HF-related readmission within 90 days of discharge (adjusted OR, 0.54; 95% CI, 0.34-0.86).
Discussion
The results of our study demonstrate that collaboration between generalists and cardiologists was associated with improved processes and outcomes of care for patients with HF who were hospitalized. These findings are important because more than half of all patients with HF in the United States receive solo care from generalists, and 10% to 30% of all patients with HF in the United States receive solo care from cardiologists,11, 28, 29 proportions that are consistent with those we observed.
Center for Medicare and Medicaid Services disclaimer
The analyses on which this publication is based were performed under Contract Number 500-96-P60, titled “Utilization and Quality Control Peer Review Organization for the State of Alabama,” sponsored by the Center for Medicare and Medicaid Services (CMS, formerly HCFA), Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Service, nor does mention of trade names, commercial products, or
Acknowledgements
We thank Crystal Walls for her secretarial assistance and Robert Farmer of Alabama Quality Assurance Foundation and Eric Bodner of University of Alabama at Birmingham Center for Aging for their contribution in data management.
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Supported by career development awards from the Southeast Center of Excellence in Geriatric Medicine and the American Federation for Aging Research to Dr Ahmed.