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Biomedical subjects

G E Thibault

Publications and source records attributed to G E Thibault.

At least 19 recordsLinked to original sources
PubMed1997

Outcomes of acute myocardial infarction in the Department of Veterans Affairs: does regionalization of health care work?

OBJECTIVES: This study examines the association between the regional availability of cardiac technology and outcomes of care for patients admitted to Department of Veterans Affairs (VA) hospitals. Patients using the VA regional medical system initially are admitted to a hospital with or without the on-site availability of technology-intensive cardiac services. METHODS: The authors identified male veterans (n = 24,229) discharged from VA hospitals with a primary diagnosis of acute myocardial infarction (AMI) from January 1, 1988 through December 31, 1990. Analyses of mortality up to 2 years after AMI and the use of cardiac procedures were stratified by the type of VA hospitals to which patients initially were admitted. Logistic regression models adjusted for age, race, marital status, hospitalization in previous year, comorbidities, cardiac complications coded, and year of AMI. RESULTS: Adjusted mortality was significantly higher for patients initially admitted to hospitals without on-site cardiac technology at: 2 days (odds ratio [OR] 0.70; 95% confidence interval [CI] 0.62-0.81), 90 days (OR 0.78; 95% CI 0.73-0.85); 1 year (OR 0.87, 95% CI 0.81-0.93); and 2 years (OR 0.86, 95% CI 0.81-0.92) compared with hospitals with on-site cardiac technology (ie, coronary angioplasty and cardiac surgery facilities). Patients initially admitted to hospitals without on-site cardiac technology also were less likely to undergo cardiac procedures than patients admitted to hospitals with on-site cardiac technology. CONCLUSIONS: The regional distribution of cardiac technology may restrict patient access to technology-intensive services and to "equally good medical care." Policies that promote regionalization of medical services should consider carefully the distribution of benefits and burdens to patients.

Cardiology Service, Hospital↗
PubMed1997

Where do elderly veterans obtain care for acute myocardial infarction: Department of Veterans Affairs or Medicare?

OBJECTIVE: To examine Department of Veterans Affairs (VA) and Medicare hospitalizations for elderly veterans with acute myocardial infarction (AMI), their use of cardiac procedures in both systems, and patient mortality. DATA SOURCES: Merging of inpatient discharge abstracts obtained from VA Patient Treatment Files (PTF) and Medicare MedPAR Part A files. STUDY DESIGN: A retrospective cohort study of male veterans 65 years or older who were prior users of the VA medical system (veteran-users) and who were initially admitted to a VA or Medicare hospital with a primary diagnosis of AMI at some time from January 1, 1988 through December 31, 1990 (N = 25,312). We examined the use of cardiac catheterization, coronary bypass surgery, and percutaneous transluminal coronary angioplasty in the 90 days after initial admission for AMI in both VA and Medicare systems, and survival at 30 days, 90 days, and one year. Other key measures included patient age, race, marital status, comorbidities, cardiac complications, prior utilization, and the availability of cardiac technology at the admitting hospital. PRINCIPAL FINDINGS: More than half of veteran-users (54 percent) were initially hospitalized in a Medicare hospital when they suffered an AMI. These Medicare index patients were more likely to receive cardiac catheterization (OR 1.24, 95% C.I. 1.17-1.32), coronary bypass surgery (OR 2.01, 95% C.I. 1.83-2.20), and percutaneous transluminal coronary angioplasty (OR 2.56, 95% C.I. 2.30-2.85) than VA index patients. Small proportions of patients crossed over between systems of care for catheterization procedures (VA to Medicare = 3.3%, and Medicare to VA = 5.1%). Many VA index patients crossed over to Medicare hospitals to obtain bypass surgery (27.6 percent) or coronary angioplasty (12.1 percent). Mortality was not significantly different between veteran-users who were initially admitted to VA versus Medicare hospitals. CONCLUSIONS: Dual-system utilization highlights the need to look at both systems of care when evaluating access, costs, and quality either in VA or in Medicare systems. Policy changes that affect access to and utilization of one system may lead to unpredictable results in the other.

Aged↗
PubMed1994

Racial variation in cardiac procedure use and survival following acute myocardial infarction in the Department of Veterans Affairs.

OBJECTIVE: To examine whether blacks admitted to Veterans Affairs Medical Centers (VAMCs) with an acute myocardial infarction (AMI) are less likely than whites to undergo cardiac catheterization or coronary revascularization procedures and to determine the impact of these differences on patient survival. DESIGN: A retrospective observational study of inpatient discharge abstracts from the Veterans Health Administration (VHA). SETTING: All one hundred fifty-eight acute care hospitals in the VHA. PATIENT POPULATION: Male veterans (n = 33,641) discharge from VAMCs with an International Classification of Diseases, Ninth Revision, Clinical Modification code for AMI from January 1, 1988, to December 31, 1990. INTERVENTION: None. MAIN OUTCOME MEASURES: The use of cardiac catheterization, coronary angioplasty, and/or bypass surgery in the 90 days after admission for AMI, and survival at 30 days, 1 year, and 2 years. MAIN RESULTS: Adjusting for patient and hospital characteristics, blacks with an AMI were 33% less likely than whites to undergo cardiac catheterization, 42% less likely to receive coronary angioplasty, and 54% less likely to receive coronary bypass surgery. Among patients who underwent catheterization, blacks were also less likely than whites to have a subsequent cardiac revascularization procedure. Adjusted 30-day survival for blacks was significantly greater than for whites. One- and 2-year survival rates after AMI were not significantly different between blacks and whites. CONCLUSIONS: In a health care system designed to provide equivalent availability of care to all eligible patients, blacks received substantially fewer cardiac procedures after AMI than whites. Despite undergoing fewer interventional procedures, blacks had better short-term and equivalent intermediate survival rates compared with whites.

Black or African American↗
PubMed1994

Refractory hypoxemia in inferior myocardial infarction from right-to-left shunting through a patent foramen ovale: a case report and review of the literature.

Right ventricular (RV) infarction is a well-recognized complication of some acute inferior myocardial infarctions. Recently, there have been numerous case reports of RV infarctions complicated by severe refractory hypoxemia secondary to right-to-left shunting through a patent foramen ovale. An additional case missed by transthoracic echocardiography and cardiac catheterization is reported and the English literature on the subject is reviewed.

Aged↗
PubMed1993

Too old for what?

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Age Factors↗
PubMed1992

Rare x rare.

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Aged↗