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Practice-Level Variation in Outpatient Cardiac Care and Association With Outcomes.

dc.contributor.author Clough, JD
dc.contributor.author Rajkumar, R
dc.contributor.author Crim, MT
dc.contributor.author Ott, LS
dc.contributor.author Desai, NR
dc.contributor.author Conway, PH
dc.contributor.author Maresh, S
dc.contributor.author Kahvecioglu, DC
dc.contributor.author Krumholz, HM
dc.coverage.spatial England
dc.date.accessioned 2016-03-01T14:23:18Z
dc.date.issued 2016-02-23
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/26908402
dc.identifier JAHA.115.002594
dc.identifier.uri http://hdl.handle.net/10161/11665
dc.description.abstract BACKGROUND: Utilization of cardiac services varies across regions and hospitals, yet little is known regarding variation in the intensity of outpatient cardiac care across cardiology physician practices or the association with clinical endpoints, an area of potential importance to promote efficient care. METHODS AND RESULTS: We included 7 160 732 Medicare beneficiaries who received services from 5635 cardiology practices in 2012. Beneficiaries were assigned to practices providing the plurality of office visits, and practices were ranked and assigned to quartiles using the ratio of observed to predicted annual payments per beneficiary for common cardiac services (outpatient intensity index). The median (interquartile range) outpatient intensity index was 1.00 (0.81-1.24). Mean payments for beneficiaries attributed to practices in the highest (Q4) and lowest (Q1) quartile of outpatient intensity were: all cardiac payments (Q4 $1272 vs Q1 $581; ratio, 2.2); cardiac catheterization (Q4 $215 vs Q1 $64; ratio, 3.4); myocardial perfusion imaging (Q4 $253 vs Q1 $83; ratio, 3.0); and electrophysiology device procedures (Q4 $353 vs Q1 $142; ratio, 2.5). The adjusted odds ratios (95% CI) for 1 incremental quartile of outpatient intensity for each outcome was: cardiac surgical/procedural hospitalization (1.09 [1.09, 1.10]); cardiac medical hospitalization (1.00 [0.99, 1.00]); noncardiac hospitalization (0.99 [0.99, 0.99]); and death at 1 year (1.00 [0.99, 1.00]). CONCLUSION: Substantial variation in the intensity of outpatient care exists at the cardiology practice level, and higher intensity is not associated with reduced mortality or hospitalizations. Outpatient cardiac care is a potentially important target for efforts to improve efficiency in the Medicare population.
dc.language eng
dc.relation.ispartof J Am Heart Assoc
dc.relation.isversionof 10.1161/JAHA.115.002594
dc.subject mortality
dc.subject physician practice variation
dc.subject population
dc.subject Aged
dc.subject Aged, 80 and over
dc.subject Ambulatory Care
dc.subject Cardiology
dc.subject Female
dc.subject Health Care Costs
dc.subject Healthcare Disparities
dc.subject Heart Diseases
dc.subject Hospitalization
dc.subject Humans
dc.subject Male
dc.subject Medicare
dc.subject Middle Aged
dc.subject Office Visits
dc.subject Practice Patterns, Physicians'
dc.subject Process Assessment (Health Care)
dc.subject Quality Indicators, Health Care
dc.subject Time Factors
dc.subject Treatment Outcome
dc.subject United States
dc.title Practice-Level Variation in Outpatient Cardiac Care and Association With Outcomes.
dc.type Journal article
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/26908402
pubs.issue 2
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Medicine
pubs.organisational-group Medicine, General Internal Medicine
pubs.organisational-group School of Medicine
pubs.publication-status Published online
pubs.volume 5
dc.identifier.eissn 2047-9980


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