Relationship Between Physician and Hospital Procedure Volume and Mortality After Carotid Artery Stenting Among Medicare Beneficiaries

被引:17
作者
Jalbert, Jessica J. [1 ,4 ]
Gerhard-Herman, Marie D. [2 ]
Nguyen, Louis L. [3 ]
Jaff, Michael R. [5 ]
Kumamaru, Hiraku [1 ]
Williams, Lauren A. [1 ]
Chen, Chih-Ying [1 ]
Liu, Jun [1 ]
Seeger, John D. [1 ]
Rothman, Andrew T. [1 ]
Schneider, Peter [6 ]
Brott, Thomas G. [7 ]
Tsai, Thomas T. [8 ]
Aronow, Herbert D. [9 ]
Johnston, Joseph A. [10 ]
Setoguchi, Soko [1 ,11 ]
机构
[1] Harvard Univ, Brigham & Womens Hosp, Sch Med, Div Pharmacoepidemiol & Pharmacoecon, Boston, MA 02115 USA
[2] Harvard Univ, Brigham & Womens Hosp, Sch Med, Div Cardiovasc Med, Boston, MA 02115 USA
[3] Harvard Univ, Brigham & Womens Hosp, Sch Med, Div Vasc & Endovasc Surg, Boston, MA 02115 USA
[4] LASER Analyt, Div Consulting & Analyt, New York, NY USA
[5] Massachusetts Gen Hosp, Div Cardiovasc Med, Boston, MA 02114 USA
[6] Kaiser Permanente Med Ctr, Div Vasc & Endovasc Surg, Honolulu, HI USA
[7] Mayo Clin, Dept Neurol, Jacksonville, FL USA
[8] Univ Colorado, Denver VA Med Ctr, Div Cardiol, Boulder, CO 80309 USA
[9] St Joseph Mercy Hosp, Div Cardiovasc Med, Ann Arbor, MI 48104 USA
[10] Eli Lilly & Co Indianapolis, Lilly Res Labs, Global Hlth Outcomes, Indianapolis, IN USA
[11] Duke Clin Res Inst, Dept Med, Durham, NC 27705 USA
来源
CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES | 2015年 / 8卷 / 06期
基金
美国医疗保健研究与质量局;
关键词
provider performance; carotid stenting; mortality; Medicare; carotid endarterectomy; STROKE RISK-FACTORS; LEARNING-CURVE; CLAIMS DATA; ENDARTERECTOMY; ACCURACY; REGISTRY; IDENTIFIERS; STENOSIS; OUTCOMES; LINKING;
D O I
10.1161/CIRCOUTCOMES.114.001668
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background- Clinical trials demonstrated the efficacy of carotid artery stenting (CAS) relative to carotid endarterectomy when performed by physicians with demonstrated proficiency. It is unclear how CAS performance may be influenced by the diversity in CAS and non-CAS provider volumes in routine clinical practice. Methods and Results- We linked Medicare claims to the Centers for Medicare and Medicaid Services' CAS Database (2005-2009). We assessed the association between 30-day mortality and past-year physician (0, 1-4, 5-9, 10-19, >= 20) and hospital (< 10, 10-19, 20-39, >= 40) CAS volumes and past-year hospital coronary and peripheral stenting volumes (< 200, 200-399, 400-849, >= 850) among beneficiaries at least 66 years of age. Unadjusted 30-day mortality risk was 1.8% (95% confidence interval [CI], 1.6-2.0) for 19 724 patients undergoing CAS by 2045 physicians in 729 hospitals. Median past-year CAS volume was 9 (interquartile range, 4-19) for physicians and 23 (interquartile range, 12-41) for hospitals. Compared to physicians performing >= 20 CAS in the past year, lower CAS volumes were associated with higher adjusted risks of 30-day morality (P value for trend < 0.05): 1.4 (95% CI, 0.9-2.3) for 0 past-year CAS, 1.3 (95% CI, 0.9-1.8) for 1 to 4, 1.1 (95% CI, 0.8-1.6) for 5 to 9, and 0.9 (95% CI, 0.7-1.4) for 10 to 19. An inverse relationship between 30-day mortality and past-year CAS hospital volume as well as past-year hospital non-CAS volume, past-year hospital non-CAS volume, and 30-day mortality was also noted. Conclusions- Among Medicare patients, an inverse relationship exists between physician and hospital CAS volumes and hospital non-CAS stenting volume and 30-day mortality, even after adjusting for all pertinent patient- and hospital-level factors.
引用
收藏
页码:S81 / S89
页数:9
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