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Variations by health region in treatment and survival after heart attack
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by Helen Johansen, Julie Bernier, Philippe Finès, Susan Brien, William Ghali and Michael Wolfson
for the Canadian Cardiovascular Outcomes Research Team
Abstract
Keywords
Findings
The data
Authors
Abstract
This article examines geographical variations in 30-day revascularization rates and 30-day in-hospital mortality rates for Canadian heart attack (acute myocardial infarction) patients. The data are from the Health Person-Oriented Information Database and pertain to health regions with at least 100,000 population in seven provinces for the years 1995/1996 and 2003/2004. Revascularization rates rose in all health regions between these years, and mortality rates dropped in most, but not all, regions. Generally, health regions with high revascularization rates had lower mortality rates. However, some regions with high revascularization rates had relatively high mortality rates, and some with relatively low revascularization rates achieved relatively low mortality rates. These results raise important questions about the overall efficiency of health care in Canada, and suggest that better data are needed to support research on explaining the wide geographical variations in treatment and survival rates for heart attack patients.
Keywords
coronary artery bypass, mortality, myocardial infarction, percutaneous coronary intervention, revascularization, small area variations
Findings
Substantial variations in the nature, extent and availability of health care across geographical areas, without any clear association with outcomes, have long been observed. Two decades ago, such variations in the United States led to calls for guidelines to determine appropriateness in the delivery of services. Investments were made in Patient Outcome Review Teams to develop clinical guidelines for deciding when a given surgical procedure or diagnostic imaging study is warranted. The underlying premise was that the wide variations might indicate that health care was being provided based on different protocols or with different benefits to patients. [Full text]
The data
The data are from the Health Person-Oriented Information Database, a linkable version of provincial computerized hospital discharge records from the Canadian Institute for Health Information Discharge Abstract Database. These hospital records have been linked to form patient trajectories. [Full text]
Authors
Helen Johansen (613-951-4273; Helen.Johansen@statcan.gc.ca), Julie Bernier (613-951-4556; Julie.Bernier@statcan.gc.ca) and Philippe Finès (613-951-3896; Philippe.Fines@statcan.gc.ca) are with the Health Analysis Division at Statistics Canada, Ottawa, Ontario, K1A 0T6. Michael Wolfson is also with Statistics Canada. Susan Brien and William Ghali are with the University of Calgary.
