PMID: 8943991Dec 1, 1996Paper

The influence of distance on ambulatory care use, death, and readmission following a myocardial infarction

Health Services Research
John D Piette, R H Moos

Abstract

To examine whether patients admitted for treatment of a myocardial infarction (MI) who live farther from their source of care are less likely to be followed in an outpatient clinic, and whether patients who receive follow-up care are less likely to die or to have a subsequent acute care admission. Department of Veterans Affairs (VA) databases to identify a national sample of 4,637 MI patients discharged in 1992, their use of care, and vital status within the subsequent year. Sociodemographics, comorbid diagnoses, invasive cardiac procedures, hospital teaching status, and distance to patients' admitting hospital were determined. Using these longitudinal data, we examined the relationship between patient characteristics, distance to care, and use of outpatient care after discharge. We then examined the relationship between the use of ambulatory care and subsequent death and readmission. Patients living more than 20 miles from their admitting hospital were less likely to use ambulatory services. Patients receiving ambulatory care were 79 percent as likely to die within the year as those without any follow-up care (95% C.I. = 0.66, 0.94). Patients living more than 20 miles from their admitting hospital were more likely to die indep...Continue Reading

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