The impact of social factors on the content of care. Treatment of ischemic heart disease at a public and a voluntary hospital.

To assess the impact of social factors on the content of care, panels of patients with ischemic heart disease at a public and its affiliated voluntary hospital were followed up through their acute hospitalizations and 3 months after discharge. Data were collected from firsthand observation of rounds, chart review, and a 3-month patient follow-up survey. Among patients for whom cardiac catheterization was indicated, 100% from the voluntary hospital underwent this procedure compared with 41% from the public institution. For patients for whom exercise stress testing was indicated, 90% from the voluntary hospital compared with 50% from the public institution underwent the procedure. Factors observed to contribute to these patterns emanated from the hospital setting as well as from the patients' social environment, including difficulties in arranging transfers for procedures, obstacles to coordinating inpatient and ambulatory care, and patient problems in keeping outpatient appointments.