Abstract 11946: Geographic Variations in Quality of Care and Outcomes Following Acute Myocardial Infarction Among Medicare Patients.

Introduction: Rural communities in the United States experience significant barriers to quality healthcare, resulting in higher incidence of disease and lower life expectancy. One potential source for such disparity may include variations in the medical care following acute myocardial infarctions (AMI), which affect approximately 1,500,000 people in the United States each year. This study sought to determine if the geographic area where Medicare patients were hospitalized following AMI predicts quality of care and short-term outcomes. Methods: Hospital-level data was quarried from the 2014 Centers for Medicare & Medicaid Services report on 'Readmissions Complications and Deaths' and 'Timely and Effective Care'. Hospitals were classified based on their geographic county, using the National Center for Health Statistics Rural-Urban Continuum Codes (RUCC), from RUCC-1 (most-urban) to RUCC-6 (most-rural). Hospital-level metrics of quality care and risk-adjusted outcomes were analyzed using Kruskal-Wallis H test and stratified by RUCC classification. Results: A total of 4,734 hospitals were identified, with 17.8% residing in RUCC-1 counties, 15.4% in RUCC-2, 16.8% in RUCC-3, 11.0% in RUCC-4, 16.4% in RUCC-5, and 22.5% in RUCC-6. There was significantly higher risk-adjusted 30-day mortality (χ2 = 95.059, p < 0.001) and rehospitalization (χ2 = 73.762, p < 0.001) among more rurally classified hospitals. Additionally, there was significantly lower measures of quality care among more rurally classified hospitals: statin at discharge (p < 0.001), aspirin prescribed at discharge (p = 0.004), primary PCI received within 90 minutes of hospital arrival (p = 0.008), aspirin at arrival (p < 0.001), and median time to ECG (p = 0.011). Linear regression analysis of the quality care metrics revealed only increased statin use at discharge was correlated with improved 30-day mortality (R2 = 0.064, p = 0.004). Conclusions: In the Medicare population, substantial variations exist between rural and urban hospitals in both the treatment and outcomes of AMI. Although existing metrics of quality care only partially correlated with short-term outcomes, identification and implementation of new strategies to improve timely and effective care are necessary to alleviate cardiovascular healthcare disparities in rural communities. [ABSTRACT FROM AUTHOR]