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Previous Volume 335:1880-1887 December 19, 1996 Number 25 Next

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ABSTRACT

Background In order to limit costs, health care organizations in the United States are shifting medical care from specialists to primary care physicians. Although primary care physicians provide less resource-intensive care, there is little information concerning the effects of this strategy on outcomes.

Methods We examined mortality according to the specialty of the admitting physician among 8241 Medicare patients who were hospitalized for acute myocardial infarction in four states during a seven-month period in 1992. Proportional-hazards regression models were used to examine survival up to one year after the myocardial infarction. To determine the generalizability of our findings, we also examined insurance claims and survival data for all 220,535 patients for whom there were Medicare claims for hospital care for acute myocardial infarction in 1992.

Results After adjustment for characteristics of the patients and hospitals, patients who were admitted to the hospital by a cardiologist were 12 percent less likely to die within one year than those admitted by a primary care physician (P<0.001). Cardiologists also had the highest rate of use of cardiac procedures and medications, including medications (such as thrombolytic agents and beta-blockers) that are associated with improved survival.

Conclusions Health care strategies that shift the care of elderly patients with myocardial infarction from cardiologists to primary care physicians lower rates of use of resources (and potentially lower costs), but they may also cause decreased survival. Additional information is needed to elucidate how primary care physicians and specialists should interact in the care of severely ill patients.

Source Information

From the Department of Medicine (J.G.J., E.D.P., D.F.F., R.M.C., D.B.M.) and the Division of Biometry, Department of Community and Family Medicine (E.R.D., L.H.M.), Duke University Medical Center, Durham, N.C.

Address reprint requests to Dr. Jollis at Box 3254, Duke University Medical Center, Durham, NC 27710.

Full Text of this Article

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Outcome of Acute Myocardial Infarction According to the Specialty of the Admitting Physician
Starfield B., Marciniak T. A., Eaton C. B., Murphy J. B., Hunt V. R., Belin D. C., Jollis J. G., DeLong E. R., Mark D. B.
Extract | Full Text  
N Engl J Med 1997; 336:1607-1609, May 29, 1997. Correspondence

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