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JCOM Abstract

J Clin Outcomes Manage 
2005 Jun;12(6):295-305
Mortality in acute myocardial infarction patients cared for by general practice physicians: effect of specialist consultation
Quan H, Fong A, Cujec B, Jin Y, Johnson D

Abstract Objective: To describe outcomes in patients hospitalized for an incident acute myocardial infarction (MI) and assess the association between outcomes and primary hospital care by general practice physicians with or without a specialist consultation. Design: Retrospective analysis of administrative data. Setting and patients: Patients in Alberta, Canada, discharged between 1994/95 and 1999/00 following admission for acute MI. Methods: Data from hospital abstracts, vital statistics, and physician claims for the study period were used to describe and analyze outcomes including mortality, costs, length of stay, and readmissions. Results: There were 19,909 acute care hospital discharges for acute MI. General/family practice (GFP) physicians without specialist consultation treated 14%, GFP physicians with a specialist consultation treated 12%, cardiologists treated 50%, internal medicine specialists treated 18%, and other specialists treated 6% of patients. GFP physicians were predominately in the 2 lower-volume quartiles (77%); internal medicine specialists (66%) and cardiologists (68%) were predominately in the 2 highest-volume quartiles. Adjusted 1-year mortality odds were lower for GFP physicians with specialist consultations (odds ratio [OR], 0.77 [95% confidence interval {CI}, 0.650.90]) compared with GFP physicians without specialist consultations. After matching by propensity score for GFP physician with specialist consultation, patients receiving hospital care by a GFP physician with specialist consultation compared with patients without specialist consultation were at reduced risk of 1-year mortality (OR, 0.73 [95% CI, 0.580.90]). Conclusion: When GFP physicians provided primary hospital care for an acute MI, survival after hospitalization tended to be higher if an internal medicine or cardiologist consultation occurred.

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