Underuse of Coronary Revascularization Procedures

Application of a Clinical Method

Published In: Journal of the American College of Cardiology, v. 29, no. 5, Apr. 1997, p. 891-897

Posted on RAND.org on January 01, 1997

by Marianne Laouri, Richard L. Kravitz, William J. French, Irene Yang, Jeffrey C. Milliken, Lee H. Hilborne, Robin Wachsner, Robert H. Brook

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This article examines underuse of coronary revascularization. The study was conducted in four public and two academically affiliated private hospitals in Los Angeles and comprises over 600 patients who underwent coronary angiography. The major finding of this study was that 75% of patients underwent a revascularization procedure, although it was expected that almost all such patients would undergo such a procedure. African Americans were less likely than whites to undergo a necessary operation, and patients in public hospitals were less likely than those in private hospitals to undergo angioplasty. This article concluded that underuse of coronary revascularization procedures is measurable and occurs to a significant degree, even among insured patients attending private hospitals. Underuse is especially pronounced among African Americans and patients attending public hospitals. Future cost-containment efforts must incorporate safeguards against underuse of necessary care.

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