Coronary artery disease, the atherosclerotic narrowing
of the arteries that supply blood to the heart, is one of the
most common chronic diseases in the United States. One million
Americans develop angina or acute myocardial infarction annually;
approximately 20% of American deaths are caused by coronary artery
disease. For those who survive, the sequelae of coronary artery
disease, including congestive heart failure, chronic angina and
cardiac arrhythmia, are serious threats to long term survival
and quality of life.
An impressive armamentarium of tests and procedures
is used in the diagnosis, management and treatment of coronary
artery disease, from echocardiography to coronary artery bypass
grafting. The high prevalence of coronary artery disease and the
vast array of available technology mean that the stakes are high
– in morbidity and mortality as well as in spending. The
rates at which these interventions are used, however, are highly
variable, and the likelihood that a patient with coronary artery
disease will have a particular test or procedure depends in large
measure on where the patient lives and seeks care.
This chapter examines the variability in treatment
of Blue Cross Blue Shield of Michigan members with coronary artery
disease. It focuses on:
- The use of diagnostic testing
- The use of therapeutic interventions
- The association between diagnostic testing
and treatment
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NOTICE
TO ATLAS READERS
While not giving answers, the atlas raises questions about
health care service use that merit careful consideration. "High"
rates of use are not necessarily bad and "low" volumes
good (or vice versa). Our goal is to move toward rates that are
consistent with high quality health care, which need to be determined
with local clinical, community and patient discussion and dialogue.
The atlas is not a physician or hospital report card. When reviewing
data, note that the Hospital Service Areas in the atlas were defined
by the atlas author. They may differ significantly from what a
hospital considers its market area.
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