Patients treated by cardiologists have a lower in-hospital mortality for acute myocardial infarction

Casale, Paul N.; Jones, Jayne L.; Wolf, Flossie; Pei, Yanfen; Eby, Ludvig

doi:10.1016/s0735-1097(98)00325-8

Cited by 109 publications

(61 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…After accounting for differences in case mix, we found that patients receiving care from higher-caseload nephrologists had greater mortality than those receiving care from lower-caseload nephrologists and that this association was robust in both categorical and restricted cubic spline analyses. The findings contrast with those of prior studies showing an inverse association between provider caseload and patient outcomes in the context of surgical 12,21 and invasive cardiovascular 11 procedures and medical conditions (e.g., acute myocardial infarction, 8 sepsis, 9 pulmonary embolus, 14 and AIDS 13 ). In a systematic review evaluating the effect of physician volume on outcomes, 69% of studies showed that high provider volume was a determinant of improved patient outcomes.…”

Section: Discussioncontrasting

confidence: 99%

“…First, it has been hypothesized that provider caseload may be a proxy for a physician's experience, knowledge, skills, and/or quality of care with which to manage particular diseases. 8,9,13 Second, there may be a selection factor in which (1) physicians who achieve favorable patient outcomes will receive more patient referrals or (2) patients may self-refer to physicians who care for patients with similar characteristics. 9,10 Third, these observations may reflect not only physician practice patterns but also the system in which the provider works.…”

Section: Discussionmentioning

confidence: 99%

“…First, the aforementioned studies of patients without ESRD examined acute procedures and conditions (e.g., pulmonary embolus 14 ) or short-term outcomes of chronic conditions (i.e., in-hospital or 30-day mortality). 8,9,11,[13][14][15]17,19 In contrast, our study evaluated long-term outcomes in a largely ambulatory setting, which is more representative of the longitudinal care that nephrologists provide to maintenance HD patients. Second, HD patients have a disproportionate burden of comorbid conditions and kidney disease-related complications and routinely undergo specialized procedures that require complex decision-making from a multidisciplinary team of providers (i.e., nephrologist, dialysis nurse, vascular access surgeon, dietician, social worker).…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12][13][14][15][16][17][18][19] Physician caseload has been inversely associated with risk of adverse outcomes for both surgical procedures 12 and medical conditions (e.g., AIDS, 13 sepsis, 9 and myocardial infarction 8 ). However, for some complex medical conditions (such as diabetes 18 and pneumonia 16 ), high physician caseload has been associated with reduced adherence to clinical practice guidelines and process measures, but not worse outcomes per se.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Nephrologist Caseload and Hemodialysis Patient Survival in an Urban Cohort

Harley

Streja

Rhee

et al. 2013

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Physician caseload may be a predictor of patient outcomes associated with various medical conditions and procedures, but the association between patient-physician ratio and mortality among patients undergoing hemodialysis has not been determined. We examined whether a higher patient-nephrologist ratio affects patient mortality risk using de-identified data from DaVita dialysis clinics and the U.S. Renal Data System. A total of 41 nephrologists with a caseload of 50-200 hemodialysis patients from an urban California region were retrospectively ranked according to their hemodialysis patient mortality rate during a 6-year period between 2001 and 2007. We calculated all-cause mortality hazard ratios for each nephrologist and compared patient-and provider-level characteristics between the 10 nephrologists with the highest patient mortality rates and the 10 nephrologists with the lowest patient mortality rates. Nephrologists with the lowest patient mortality rates had significantly lower patient caseloads than nephrologists with the highest mortality rates (median [interquartile range], 65 [55-76] versus 103 [78-144] patients per nephrologist, respectively; P,0.001). Additionally, patients treated by nephrologists with the lowest patient mortality rates received higher dialysis doses, had longer sessions, and received more kidney transplants. In demographic characteristic-adjusted analyses, each 50-patient increase in caseload was associated with a 2% increase in patient mortality risk (hazard ratio, 1.02; 95% confidence interval, 1.00 to 1.04; P,0.001). Hence, these results suggest that nephrologist caseload influences hemodialysis patient outcomes, and future research should focus on identifying the factors underlying this association.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Nephrologist Caseload and Hemodialysis Patient Survival in an Urban Cohort

Harley

Streja

Rhee

et al. 2013

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…5,6 Similarly, patients with unstable angina are less likely to receive effective treatments if treated by generalists rather than cardiologists. 7,8 In addition, compared with generalists, cardiologists are less likely to order tests but prescribe more medications for hypertension and ischemic heart disease.…”

mentioning

confidence: 99%

Family Medicine Outpatient Encounters are More Complex Than Those of Cardiology and Psychiatry

Katerndahl¹,

Wood²,

Jaén³

2011

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

Background:Comparison studies suggest that the guideline-concordant care provided for specific medical conditions is less optimal in primary care compared with cardiology and psychiatry settings. The purpose of this study is to estimate the relative complexity of patient encounters in general/family practice, cardiology, and psychiatry settings.Methods: Secondary analysis of the 2000 National Ambulatory Medical Care Survey data for ambulatory patients seen in general/family practice, cardiology, and psychiatry settings was performed. The complexity for each variable was estimated as the quantity weighted by variability and diversity.Results: There is minimal difference in the unadjusted input and total encounter complexity of general/family practice and cardiology; psychiatry's input is less complex. Cardiology encounters involved more input quantitatively, but the diversity of general/family practice input eliminated the difference. Cardiology also involved more complex output. However, when the duration of visit is factored in, the complexity of care provided per hour in general/family practice is 33% more relative to cardiology and 5 times more relative to psychiatry.Conclusions: Care during family physician visits is more complex per hour than the care during visits to cardiologists or psychiatrists. This may account for a lower rate of completion of process items measured for quality of care. (J Am Board Fam Med 2011;24:6 -15.)

show abstract

Medical Records and Quality of Care in Acute Coronary Syndromes

et al. 2008

View full text Add to dashboard Cite

Background: Patient medical records are important means of communication among health care providers. Limited evaluation has been performed of the quality of the medical records or its association with health care processes or outcomes. Methods: We performed an empirical evaluation of the completeness of medical records from 607 randomly selected patients admitted with non-ST-segment elevation acute coronary syndromes (NSTE ACS) to 219 US hospitals in the CRUSADE National Quality Improvement Initiative. Composite medical records scores were summated and compared by hospital academic status and physician specialty. Correlations between medical records scores, use of evidence-based medicine (EBM), and in-hospital mortality were assessed. Results: Medical records were frequently missing key elements, including cardiac history (23.6%), performance status (64.6%), differential diagnosis (57.8%), and planned use of EBM (44.0%). Evidence-based medicine was more often discussed in medical records from academic medical centers vs nonacademic medical centers (69.7% vs 51.7%) (PϽ .001) and from cardiologists vs noncardiologists (60.5% vs 48.1%, P=.003). Higher medical records quality scores were associated with greater use of EBM among the medical records quality cohort (P=.006), and a similar trend was observed in CRUSADE overall: adjusted odds ratio, 1.26 (95% confidence interval, 0.92-1.72) for high vs low medical records quality. Higher medical records quality scores were associated with lower in-hospital mortality: adjusted odds ratio, 0.79 (95% confidence interval, 0.65-0.97). Conclusions: Medical records for patients with NSTE ACS often lack key elements of the history and physical examination. Patients treated at hospitals with better medical records quality have significantly lower mortality and may receive more EBM. The relationship between better medical charting and better medical care could lead to new ways to monitor and improve the quality of medical care.

show abstract

Patients treated by cardiologists have a lower in-hospital mortality for acute myocardial infarction

Cited by 109 publications

References 13 publications

Nephrologist Caseload and Hemodialysis Patient Survival in an Urban Cohort

Nephrologist Caseload and Hemodialysis Patient Survival in an Urban Cohort

Family Medicine Outpatient Encounters are More Complex Than Those of Cardiology and Psychiatry

Medical Records and Quality of Care in Acute Coronary Syndromes

Contact Info

Product

Resources

About