Patient-centered care and outcomes after myocardial infarction

• Objective: To examine the relationship between patient-reported experience of hospital care for acute myocardial infarction (AMI) and subsequent outcomes. • Design: Prospective observational cohort study. • Setting/participants: 2272 AMI patients discharged from 23 New Hampshire hospitals during 1996 and 1997. • Measurements: Outcomes included cardiac rehospitalizations and/or cardiac mortality within the first year. We used patient responses to Picker survey items about their care to compute an overall problem score, classifying patients with top quartile scores as "worse care" and others as "better care." Propensity score matching was used to adjust for baseline differences in selected demographic and clinical characteristics between the 2 groups. • Results: Postdischarge surveys were completed by 1253 (55%) eligible patients. In unmatched analyses, better care patients had an equivalent annual rate of cardiac rehospitalization or cardiac death compared with worse care patients (-0.09 [95% confidence interval {CI}, -0.19 to 0.01]; P = 0.11). Propensity score matching did not reveal a difference in annual cardiac event rates between worse and better care patients (0.05 [95% CI, -0.09 to 0.2]; P = 0.48). • Conclusion: Patient-reported problems with AMI hospital care were not predictive of 1-year cardiac events among this cohort of New Hampshire patients. Larger cohort studies in other settings would help clarify whether associations differ in more diverse patient populations and detect any small, but clinically important, effects.