UNDERUSE OF CORONARY REVASCULARIZATION PROCEDURES - APPLICATION OF A CLINICAL METHOD

Objectives. Our main objective was to apply a new method to determine whether coronary revascularization procedures are underused, especiall y among African-Americans and uninsured patients. Background. Although overuse of revascularization procedures has been studied, underuse as defined clinically has not been examined before. Methods. The study w as conducted at four public and two academically affiliated private ho spitals in Los Angeles; 671 patients, who underwent coronary angiograp hy between June 1, 1990 and September 30, 1991 and met explicit clinic al criteria for coronary revascularization were included. The main out come measure was the proportion of patients undergoing an indicated pr ocedure within 12 months (ascertained by medical record review and con firmed with a telephone survey). Adjusted relative odds of undergoing an indicated procedure for African-Americans and patients in public ho spitals compared with whites and patients in private hospitals were ca lculated. Results. Overall, 75% of patients underwent a revascularizat ion procedure. Of 424 patients requiring bypass surgery, 107 angioplas ty and 140 either bypass surgery or angioplasty, 59%, 66% and 75% unde rwent the procedure, respectively. African-Americans were less likely than whites to undergo operation (adjusted odds ratio [OR] 0.49, p < 0 .05) and angioplasty (adjusted OR 0.20, p < 0.05). Patients in public hospitals were less likely than those in private hospitals to undergo angioplasty (adjusted OR 0.10, p < 0.005). Conclusions. Underuse of co ronary revascularization procedures is measurable and occurs to a sign ificant degree even among insured patients attending private hospitals . Underuse is especially pronounced among African-Americans and patien ts attending public hospitals. Future cost-containment efforts must in corporate safeguards against underuse of necessary care.