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Is There an Association Between Quality of In-Hospital Cardiac Care and Proportion of Low-Income Patients?

Culler, Steven D. PhD*; Schieb, Linda MSPH; Casper, Michele PhD; Nwaise, Isaac MA; Yoon, Paula W. ScD, MPH

doi: 10.1097/MLR.0b013e3181c161ba
Brief Report

Background: Process measures have been developed and implemented to evaluate the quality of care patients receive in the hospital. This study examines whether there is an association between the quality of in-hospital cardiac care and a hospital's proportion of low-income patients.

Methods and Results: A retrospective analysis of 1979 hospitals submitting information on 12 quality of care (QoC) process measures for acute myocardial infarction (AMI) and congestive heart failure (CHF) patients to the Hospital Quality Alliance during 2005 and 2006 and meeting all study inclusion criteria. Mean hospital performance ranged from 84.2% (ACE inhibitor for left ventricular systolic dysfunction) to 95.9% (aspirin on arrival) for AMI QoC process measures and from 64.4% (discharge instructions) to 92.4% (left ventricular function assessment) for CHF QoC process measures. Regression analyses indicated a statistically significant negative association between the proportion of low-income patients and hospital performance for 10 of the 12 cardiac QoC process measures, after controlling for selected hospital characteristics.

Conclusions: Hospital adherence to QoC process measures for AMI and CHF patients declined as the proportion of low-income patients increased. Future research is needed to examine the role of community characteristics and market forces on the ability of hospitals with a disproportionate share of low-income patients to maintain the staffing, equipment, and policies necessary to provide the recommended standards of care for AMI and CHF patients.

From the *Department of Health Policy and Management Rollins School of Public Health, Emory University, Atlanta, GA; and †Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Reprints: Steven D. Culler, PhD, Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.