Thursday, June 30, 2011

Care in U.S. Territories Found Lacking

By Charles Bankhead, Staff Writer, MedPage Today
Published: June 28, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
The territorial hospitals included in the analysis had a 30-day risk-standardized mortality of 18.8% for acute MI versus 16% for hospitals in the states (P<0.001). Similar mortality disparities existed for heart failure (12.3% versus 10.8%, P<0.001) and pneumonia (14.9% versus 11.4%, P<0.001).

Hospitals in U.S. territories, including Puerto Rico, have significantly higher 30-day mortality rates and worse outcomes for myocardial infarction, heart failure, and pneumonia, according to a review of Medicare data.

The mortality differences raise concern about the quality of care in territorial hospitals, investigators stated in an article published online in Archives of Internal Medicine.

The U.S. has jurisdiction over several unincorporated territories, including Puerto Rico, Guam, American Samoa, the Northern Mariana Islands, and the U.S. Virgin Islands. These territories have a combined five million residents, almost all of whom self-identify as racial or ethnic minorities, Marcella Nunez-Smith, MD, of Yale School of Medicine, and co-authors noted in their introduction.