Care following Acute Myocardial Infarction in the Veterans Administration Medical Centers: A Comparison with Medicare

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Abstract
Objective. To compare patients treated for acute myocardial infarction (AMI) in a Veterans Health Administration (VHA) facility to similar patients treated under Medicare.Data Sources. Administrative data on 13,129 elderly male veterans hospitalized for AMI in a VHA facility between October 1, 1996, and September 30, 1999, and a matched set of male Medicare beneficiaries with AMI treated in a non‐VHA facility during the same time period.Study Design. We conducted a retrospective cohort study using propensity score methods to identify a matched set of male elderly AMI patients treated either in a VHA facility or in a non‐VHA facility under Medicare. We compared the two groups of patients according to characteristics of the admitting hospital, distances traveled for care, the use of invasive procedures, and mortality. We assessed the robustness of our conclusions to biases arising from unmeasured confounders using sensitivity analyses.Principal Findings. VHA patients were significantly less likely than Medicare beneficiaries to be admitted to high‐volume facilities (for example, 25 percent versus 46 percent in 1999, ppConclusions. We observed differences in the way care for AMI patients was structured, in the use of invasive therapies, and in long term mortality between patients treated in VHA hospitals and those treated in non‐VHA facilities under Medicare. Future research should focus on explanations for the differences between the two systems and for the reduction in short‐term mortality among VHA patients. Further study of these differences both between and within the systems of care may help identify cost‐effective strategies to improve care in both sectors.

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