Urban-rural differences in the quality of care for Medicare patients with acute myocardial infarction

Background: There are urban-rural differences in health care utilization in Kansas. This study was conducted to determine if similar differences exist in the quality of inpatient care provided for patients with acute myocardi al infarction (AMI). Methods: All acute care hospitals in the state were stratified into 12 urba n, 31 semirural, and 76 rural hospitals according to their location. Data f rom medical records of 2521 Medicare patients 65 years and older who had su rvived AMI and were discharged alive from hospitals during an 8-month perio d in 1994/1995 were abstracted. The measures of the quality of care (qualit y indicators [QIs]) were the use of aspirin (during hospital stay and at di scharge) and the administration of beta -blockers, intravenous (IV) nitrogl ycerin, heparin, and reperfusion by thrombolytic therapy or primary angiopl asty. Results: A significantly higher proportion of ideal candidates for the use of aspirin during hospital stay and at discharge, heparin, and IV nitroglyc erin received these medications in urban hospitals, and a lower proportion of similar patients received these medications in rural hospitals compared with the patients in semirural hospitals (P<.001). Similar trends in each o f the 6 QIs were observed for less than ideal patients (P<.05). Patient age was associated with a relatively poor quality of care in terms of the 6 QI s. Except for the administration of IV nitroglycerine to less than ideal pa tients, age adjustments did not change the observed urban-rural differences in the QI measures. Conclusion: Relatively poor quality of care for patients with AMI was provi ded by rural hospitals where greater opportunity for improvement exists.