Biased estimates of expected acute myocardial infarction mortality using MedisGroups admission severity groups

Article Abstract:

The severity of acute myocardial infarction (heart attack) can be classified according to the MedisGroups (Medical Illness Severity Grouping System). It is required that this system be used in all hospitals in Pennsylvania, so that individuals can be informed about the quality of care they are likely to receive at each hospital and can be guided as to which hospital to use. The MedisGroups system is also used by insurance companies to encourage people to seek care from certain hospitals. A study was conducted to determine whether the MedisGroups are adequate, or unbiased, for estimating the death rate of 3,037 Medicare-aged patients who suffered a heart attack. Specifically, the study examined the deaths that occurred within the first 30 days after the attack. The observed deaths were compared with the estimated deaths, which were based on the severity rating. It was found that the estimated death rates were biased for many factors, including the age of the patient, the location in the heart where the attack occurred, if there was a history of heart failure, the levels of potassium and urea in the blood, the pulse rate and blood pressure. Some of these findings, such as pulse rate and blood pressure, can change after admission; they may only reflect the status of the patient at the time of admission. These should not be used as predictive factors in the rating the severity of illness. MedisGroups does not consider some important risk factors, while other risk factors are given too much importance. Some hospital records are not complete and missing data are not distinguished from normal values. These findings demonstrate that the MedisGroups criteria are not useful for comparing the quality and cost of care at various hospitals. Solutions to the problems are presented. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Medical economics, Surveys, Medical care, Quality management, Medical care quality, Hospitalization, Hospital care

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Changing seasonality of mortality from coronary heart disease

Article Abstract:

The widespread introduction of central heating and air conditioning has changed the seasonal pattern of death from coronary heart disease and may also be responsible for reduced mortality rates. Analysis of mortality rates reveals that the seasonal variation in mortality decreased until 1970, when it began to reverse. This trend was most pronounced in New England and was hardly noticeable in the South. This coincides with the introduction of central heating in the colder parts of the US. The introduction of air conditioning after 1970 also could have affected seasonal mortality patterns.

Health aspects, Analysis, Environmental aspects, Air conditioning, Heating, Seasonal variations (Diseases)

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Mortality From Coronary Heart Disease and Acute Myocardial Infarction--United States, 1998

Article Abstract:

Coronary heart disease caused 459,841 deaths in 1998, and 203,551 (44%) were the result of a heart attack. About 12 million Americans have coronary heart disease in 2001, and about one million will have a heart attack in 2001.

Statistical Data Included

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