Practice-level variation in outpatient cardiac care and association with outcomes

Jeffrey D. Clough, Rahul Rajkumar, Matthew T. Crim, Lesli S. Ott, Nihar R. Desai, Patrick H. Conway, Sha Maresh, Daver C. Kahvecioglu, Harlan M. Krumholz

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish (US)
Article numbere002594
JournalJournal of the American Heart Association
Volume5
Issue number2
DOIs
StatePublished - Jan 1 2016

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Ambulatory Care
Hospitalization
Cardiology
Outpatients
Medicare
Office Visits
Myocardial Perfusion Imaging
Electrophysiology
Cardiac Catheterization
Odds Ratio
Physicians
Equipment and Supplies
Mortality
Population

Keywords

  • Mortality
  • Physician practice variation
  • Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Clough, J. D., Rajkumar, R., Crim, M. T., Ott, L. S., Desai, N. R., Conway, P. H., ... Krumholz, H. M. (2016). Practice-level variation in outpatient cardiac care and association with outcomes. Journal of the American Heart Association, 5(2), [e002594]. https://doi.org/10.1161/JAHA.115.002594

Practice-level variation in outpatient cardiac care and association with outcomes. / Clough, Jeffrey D.; Rajkumar, Rahul; Crim, Matthew T.; Ott, Lesli S.; Desai, Nihar R.; Conway, Patrick H.; Maresh, Sha; Kahvecioglu, Daver C.; Krumholz, Harlan M.

In: Journal of the American Heart Association, Vol. 5, No. 2, e002594, 01.01.2016.

Research output: Contribution to journalArticle

Clough, JD, Rajkumar, R, Crim, MT, Ott, LS, Desai, NR, Conway, PH, Maresh, S, Kahvecioglu, DC & Krumholz, HM 2016, 'Practice-level variation in outpatient cardiac care and association with outcomes', Journal of the American Heart Association, vol. 5, no. 2, e002594. https://doi.org/10.1161/JAHA.115.002594
Clough, Jeffrey D. ; Rajkumar, Rahul ; Crim, Matthew T. ; Ott, Lesli S. ; Desai, Nihar R. ; Conway, Patrick H. ; Maresh, Sha ; Kahvecioglu, Daver C. ; Krumholz, Harlan M. / Practice-level variation in outpatient cardiac care and association with outcomes. In: Journal of the American Heart Association. 2016 ; Vol. 5, No. 2.
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