Quality of ASCVD Care Varies by Region Throughout United States

A new analysis from Johns Hopkins School of Medicine has found that quality of care for patients with atherosclerotic cardiovascular disease (ASCVD) can vary depending on what part of the country they live in.

Results of the analysis, which assessed differences in patient-reported outcomes, revealed patients treated in the Midwest, South, and West regions all reported poorer health-related quality of life than patients treated in the Northeast.

In an effort to determine how geographic region could impact patient experience, health resource utilization, and secondary prevention in adults with ASCVD, investigators conducted an analysis using data from the Medical Expenditure Panel Survey(MEPS). Using a time frame of 2006 to 2015, investigators identified a cohort of 21,353 patients diagnosed with stroke, peripheral artery disease, or coronary artery disease through ICD-9 codes or self-reported data.

All patients included in the study completed the MEPS Consumer Assessment of Health Provider and Systems survey, which assessed patient satisfaction, perception of health, and patient-provider communication. Investigators obtained information on health resource utilization, health-related quality of life, and perception of health status through phone surveys while medication use was obtained through self-report and pharmacy prescription data.

For the purpose of the investigators' analysis, sex/gender, race/ethnicity, level of education, income, age, and insurance status were all included as covariates during statistical analyses. Investigators defined the Northeast region as PA, NY, CT, VT, NH, ME, MA, RI, and NJ; West was defined as OR, CA, AZ, NM, AK, NV, WA, MT, ID, WY, UT, and CO; Midwest was defined as NS, SD, NE, KS, MO, IA, MN, WI, IL, MI, OH, and IN; South was defined as TX, OK, AR, AL, MS, LA, TN, KY, WV, GA, FL, SC, NC, MD, DE, DC, and VA.

Analyses revealed that while healthcare utilization was similar across all regions, there were significant differences in multiple other aspects related to ASCVD care. All regions reported worse physical health-related quality of life compared to those in the Northeast, with patients in the South (OR: -2.15 (95% CI -2.68, -1.63)) reporting the worst outcomes followed by the West (-1.56 (95% CI -2.07, -1.05)) and then the Midwest (-1.55 (95% CI -2.13, -1.00)).

Additionally, investigators observed adults living in the West were more likely to report poor patient-provider communication (1.34 (95% CI 1.10-1.63)) and poor satisfaction (1.29 (95% CI 1.13-1.48)) when compared to adults living in the Northeast.

Analyses also revealed specific trends in each region. Patients in the Midwest were the less likely to report aspirin use (0.84 (95% CI 0.75-0.94)) while patients in the South were more likely to report a poor perception of health (1.24 (95% CI 1.09-1.40) compared to Northeast patients.

“This consideration of regional differences in patient experiences with their healthcare underscores the importance of patient reported outcomes,” investigators wrote.

This study, titled “Differences in Patient Healthcare Experience by Geographic Region Among Adults With Atherosclerotic Cardiovascular Disease,” was presented at the American Heart Association (AHA) 2019 Scientific Sessions in Philadelphia.