Evaluating health system performance: Access to interventional cardiology for acute cardiac events in the rural Medicare population

This study examined the accessibility of acute cardiac services for rural Medicare beneficiaries. This descriptive cross-sectional study utilized the Medicare.Current Beneficiary Survey (MCBS) to examine the admissions for 382 rural cardiac patients during the years of 1996 through 1998. Claims data associated with the M CBS was used to detail information regarding diagnoses, procedures, transfers, charges, and discharge status.{09}Cardiac procedure data from MedPar files provided hospital volumes for coronary artery bypass grafting, percutaneous transluminal coronary angioplasty and cardiac catheterization. The Behavioral Model of Health Care Utilization provided the structure to examine present practices and access to cardiac services for rural Medicare beneficiaries.; The analysis focused on determining the extent to which clinical and personal characteristics of the rural beneficiary influenced admission to hospitals with the full range of emergent interventional cardiac services. Beneficiary descriptions of rurality were defined by the urban influence code assigned to their county of residence. Distance to admitting hospital was calculated using a geographic information system program. Outcomes were evaluated as the change in the beneficiary's perception of their own health, their satisfaction with their health care, post-discharge utilization of health care services, and time to readmission.; Several characteristics were significantly associated with either primary admission or transfer to hospitals offering the full range of cardiac interventions. These beneficiaries tended to be younger and male. They were also more likely to have higher education levels, higher income, private insurance policies in addition to their Medicare coverage, were married, and were living with their spouse. Those beneficiaries who were admitted to these level one facilities traveled significantly farther than did those who were admitted to hospitals with either limited to no cardiac interventions available. Outcome measures of satisfaction, self-reported general health, and time to readmission did not vary by accessibility to interventional cardiology.