Jornal da Síndrome Metabólica

Inpatients Outcomes Following Diabetic Myocardial Infarction: Income, Insurance, and Length of Stay in Teaching vs. Nonteaching Hospitals in the United States

Abstract

Priscilla O Okunji, Johnnie Daniel and Anthony Wutoh

This paper assesses whether there is a significant difference in socioeconomic condition (income), insurance status, and Length of Stay (LOS) of inpatients diagnosed with diabetic myocardial infarction in teaching vs nonteaching hospitals. A retrospective data analysis of discharges was conducted from the 2008 Healthcare Cost and Utilization Project, Nationwide Inpatient Sample. Sample selection was based on the International Classification of Diseases, Ninth Revision, codes with LOS as the outcome variable. Teaching hospitals have longer LOS compared to nonteaching hospitals for patients with incomes below $48,000 (χ2=16.185, df=6, P < 0.013). The duration of hospital LOS is higher in teaching than in nonteaching hospitals for patient insurance (χ2=24.975, df=6, P=0.0001). For patients with Medicare, the hospital stay of 1 day and less is lower in nonteaching hospitals. Teaching hospitals have higher rates of LOS than nonteaching hospitals for the age group, 65-74 (χ2=37.294, df=6, P=0.0001). Especially for hospital stays of more than 6 days, the LOS is higher in teaching hospitals. The difference in LOS in teaching and nonteaching hospitals is statistically significant for males (P=0.009) vs. females (P=0.003). The results of this study indicate that the difference in LOS between teaching and nonteaching hospitals based on patient age, income, and insurance is statistically significant. When one controls for the independent variables in this study, the difference presented is large enough to affect clinical policy. These findings highlight the need for interventions to increase awareness of health care disparities that exist among inpatients with diabetic myocardial infarction, especially for low-income and older patients who do not qualify for Medicare.