Rural and Urban Care Quality Compared for CAD

Study finds that quality of care is similar in rural and urban hospitals after adjustment for variables
By Jeff Muise
HealthDay Reporter

FRIDAY, Jan. 29 (HealthDay News) -- After adjustment for variables, hospital quality of care for coronary artery disease (CAD) in rural areas is on a par with care in urban areas, according to a study in the Jan. 15 issue of the American Journal of Cardiology.

Amrut V. Ambardekar, M.D., of the University of Colorado at Denver, and colleagues analyzed data from 22,096 patients at 71 rural hospitals and 329,938 patients at 477 urban hospitals in the Get With the Guidelines-CAD Program (GWTG-CAD) from 2000 to 2008. Quality of care and in-hospital outcomes for the rural and urban hospitals were compared for in-hospital mortality, length of stay, and compliance with GWTG-CAD quality metrics, including early aspirin use; smoking cessation counseling and prescriptions; continuing aspirin; angiotensin-converting enzyme inhibitors or angiotensin receptor blockers use (in cases of left ventricular systolic dysfunction); β-blocker use; and lipid-lowering therapy. A composite incorporating all six metrics was calculated.

The researchers found that unadjusted compliance with quality metrics was lower in the rural hospitals, as was the composite score (74.7 percent rural versus 80.6 percent urban). However, after adjustment for patient and hospital variables, rural hospitals no longer had lower compliance than urban hospitals. Similarly, unadjusted mortality rates were higher in rural hospitals (5.7 versus 4.4 percent), but the difference was not significant after adjustment.

"In conclusion, within the GWTG-CAD quality improvement initiative, patients with CAD treated at rural hospitals receive similar quality of care and have similar outcomes as those at urban centers," the authors write.

The study was supported in part through an unrestricted educational grant from the Merck Schering Plough Partnership.

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