Preventing Chronic Disease | Preventable Hospitalizations and Emergency Department Visits for Angina, United States, 1995–2010 - CDC

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Preventing Chronic Disease | Preventable Hospitalizations and Emergency Department Visits for Angina, United States, 1995–2010 - CDC

Preventable Hospitalizations and Emergency Department Visits for Angina, United States, 1995–2010

Julie C. Will, PhD, MPH; Amy L. Valderrama, PhD, RN; Paula W. Yoon, ScD, MPH

Suggested citation for this article: Will JC, Valderrama AL, Yoon PW. Preventable Hospitalizations and Emergency Department Visits for Angina, United States, 1995–2010. Prev Chronic Dis 2013;10:120322. DOI: http://dx.doi.org/10.5888/pcd10.120322.

MEDSCAPE CME Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Preventing Chronic Disease. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at www.medscape.org/journal/pcd; (4) view/print certificate. Release date: July 24, 2013; Expiration date: July 24, 2014

Learning Objectives Upon completion of this activity, participants will be able to: Evaluate trends in emergency department visits for chest pain Analyze characteristics of emergency department visits for angina in the current study Analyze characteristics of hospitalizations for angina in the current study Distinguish patterns in preventable emergency department visits and hospitalizations for angina over time EDITORS Caran Wilbanks, Editor, Preventing Chronic Disease. Disclosure: Caran Wilbanks has disclosed the following relevant financial relationship: Partner is employed by McKesson Corporation CME AUTHOR Charles P. Vega, MD, Associate Professor and Residency Director, Department of Family Medicine, University of California, Irvine. Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships. AUTHORS AND CREDENTIALS Disclosures: Julie C. Will, PhD, MPH, owns stock, stock options, or bonds from Johnson & Johnson and Pfizer. Amy L. Valderrama, PhD,and Paula W. Yoon, ScD, MPH have disclosed no relevant financial relationships. Affiliation: Julie C. Will, Amy L. Valderrama, and Paula W. Yoon, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Abstract

Introduction
Preventable hospitalizations for angina have been decreasing since the late 1980s — most likely because of changes in guidance, physician coding practices, and reimbursement. We asked whether this national decline has continued and whether preventable emergency department visits for angina show a similar decline.
Methods
We used National Hospital Discharge Survey data from 1995 through 2010 and National Hospital Ambulatory Medical Care Survey data from 1995 through 2009 to study preventable hospitalizations and emergency department visits, respectively. We calculated both crude and standardized rates for these visits according to technical specifications published by the Agency for Healthcare Research and Quality, which uses population estimates from the US Census Bureau as the denominator for the rates.
Results
Crude hospitalization rates for angina declined from 1995–1998 to 2007–2010 for men and women in all 3 age groups (18–44, 45–64, and ≥65) and age- and sex-standardized rates declined in a linear fashion (P = .02). Crude rates for preventable emergency department visits for angina declined for men and women aged 65 or older from 1995–1998 to 2007–2009. Age- and sex-standardized rates for these visits showed a linear decline (P = .05).
Conclusion
We extend previous research by showing that preventable hospitalization rates for angina have continued to decline beyond the time studied previously. We also show that emergency department visits for the same condition have also declined during the past 15 years. Although these declines are probably due to changes in diagnostic practices in the hospitals and emergency departments, more studies are needed to fully understand the reasons behind this phenomenon.

Hospitalizaciones y visitas prevenibles por angina de pecho a departamentos de emergencia, Estados Unidos, 1995–2010

Julie C. Will, PhD, MPH; Amy L. Valderrama, PhD, RN; Paula W. Yoon, ScD, MPH

Suggested citation for this article: Will JC, Valderrama AL, Yoon PW. Preventable Hospitalizations and Emergency Department Visits for Angina, United States, 1995–2010. Prev Chronic Dis 2013;10:120322. DOI: http://dx.doi.org/10.5888/pcd10.120322.

REVISADO POR EXPERTOS

Resumen

Introducción
Las hospitalizaciones prevenibles por angina de pecho han estado disminuyendo desde finales de la década de los ochenta, probablemente debido a los cambios en las pautas, las prácticas de codificación médica, y rembolso. Preguntamos si esta disminución a nivel nacional ha continuado y si las visitas prevenibles a departamentos de emergencia por angina de pecho muestran una disminución similar.
Métodos
Usamos datos de la Encuesta Nacional de Altas Hospitalarias desde 1995 hasta el 2010 y de la Encuesta Nacional sobre Atención Médica Ambulatoria en Hospitales desde 1995 hasta el 2009 para estudiar hospitalizaciones y visitas a departamentos de emergencia prevenibles, respectivamente. Calculamos tanto las tasas preliminares como las estandarizadas para estas visitas según especificaciones técnicas publicadas por la Agencia para la Investigación y Calidad de la Atención Médica, la cual usa como denominador de las tasas cálculos poblacionales de la Oficina del Censo de los EE. UU.
Resultados
Las tasas de hospitalizaciones preliminares por angina de pecho disminuyeron desde 1995–1998 a 2007–2010 (18–44, 45–64, y ≥65), y las tasas estandarizadas por edad y sexo disminuyeron de una manera lineal (P = .02). Las tasas preliminares para las visitas prevenibles a departamentos de emergencia por angina de pecho disminuyeron en los hombres y en las mujeres mayores de 65 años desde 1995–1998 a 2007–2009. Las tasas estandarizadas por edad y sexo para estas visitas mostraron una disminución lineal (P = .05).
Conclusión
Ampliamos investigaciones previas demostrando que las tasas de hospitalizaciones prevenibles por angina de pecho han continuado disminuyendo más allá del tiempo previamente estudiado. También mostramos que las visitas a departamentos de emergencia por la misma afección también han disminuido durante los últimos 15 años. Aunque estas disminuciones probablemente se deban a cambios en las prácticas de diagnóstico en los hospitales y departamentos de emergencia, se necesitan más estudios para entender completamente las razones de este fenómeno.