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KCE reports vol. 19B Urgences 111
Publication
Data
Magid J.D. et
al.-NEJM-vol.
336-nr.24.june
1997.
USA-
Colorado
MESH-terms Objective Planning Conclusion Material/Methods Results / Comments Comments/Discussion
Copayment(copa
) and delays in
ED.
Study of the
impact of copas
in reducing
inappropriate
visits to ED.
Quid fot
emergencies
like AMI??
Retrospective.(
multicenter
study
myocardial
infarction triage
and
intervention:
MITI)
Not
randomized, but
selected.(1
HMO- Seattle)
Not controlled,
but
comparative.
Modest, fixed
copas for DEuse
did not lead
to delays in
seeking
treatment for
AMI.
500.000 enrolees in a group
health cooperative, insured
with employers or gvt.
agencies.
AMI =initial diagnosis.
Subscription for ED-copa is
not a matter of choice for
>90 % of the enrolees.
Key-topic: analysis of time
between the onset of
symptoms and the arrival in
hospital, among copa- and
non-copagrps.
Variables:-demographic(age,
sex, race)
-clinical(chest
pain, dyspnoe...)
-cardiac history.
-socioeconomic status,
linking each personal
address to his census
block(89 % available).
Indicators: education, family
income.
o X2 test, fisher
exact, student
test.
o Degree of
awareness is also
No significant differences in
analysed data between copa
and non copagrps under and
above 65 yrs.
Overall studied mean time
was 136 min.
The variables, former
angioplasty, chest pain,
nausea, diaphoresis, are
statistically significant for a
earlier call and arrival in
hosp.
Age-adjusted median time
was 136 min.for non
copa,135 min. For copas=25
Usd,138 min for copa> 50
Usd.
Adjustment for age, sex,
race, cardiac history, amount
of copa, median income,
education level=same
results.
In subgrp of 305 pat. with
previous visit to ED and
awareness of copa: 141 min.
in the copagrp, 164 min in
the noncopagrp.(p= 0,28).
No significant association
between copa satus and
occurrence of cardiac arrest.
No significant difference in
- This study shows no
significant differences in
the time to arrive in the
hospital between copa
and non copagrps. Even
after adjustment for all
indicators.
- Regression analysis
adjusted for demographic
factors, shows with a
confidence rate of 95 %
that the time to arrive in
the hospital for AMI isnÊt
longer than 16 min foe
the copa than the noncopagrp.(???)
- Limitations to the study: -
no effect on co-payment
on AMI-pat. who stayed at
home fot their
treatment.(but this are
not the most urgent
cases, for whom a delay
would have been harmful).
- no assessment of this
managed care on the
quality of care.
-