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Relationship Between Physician and Hospital Procedure Volume and Mortality After Carotid Artery Stenting Among Medicare Beneficiaries.
Jalbert, Jessica J; Gerhard-Herman, Marie D; Nguyen, Louis L; Jaff, Michael R; Kumamaru, Hiraku; Williams, Lauren A; Chen, Chih-Ying; Liu, Jun; Seeger, John D; Rothman, Andrew T; Schneider, Peter; Brott, Thomas G; Tsai, Thomas T; Aronow, Herbert D; Johnston, Joseph A; Setoguchi, Soko.
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  • Jalbert JJ; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
  • Gerhard-Herman MD; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
  • Nguyen LL; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
  • Jaff MR; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
  • Kumamaru H; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
  • Williams LA; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
  • Chen CY; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
  • Liu J; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
  • Seeger JD; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
  • Rothman AT; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
  • Schneider P; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
  • Brott TG; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
  • Tsai TT; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
  • Aronow HD; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
  • Johnston JA; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
  • Setoguchi S; From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., L.A.W., C.-Y.C., J.L., J.D.S., A.T.R., S.S.), Division of Cardiovascular Medicine (M.D.G.-H.), and Division of Vascular and Endovascular Surgery (L.L.N.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
Circ Cardiovasc Qual Outcomes ; 8(6 Suppl 3): S81-9, 2015 Oct.
Article en En | MEDLINE | ID: mdl-26515214
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Médicos / Arterias Carótidas / Estenosis Carotídea / Implantación de Prótesis Vascular / Hospitales de Alto Volumen Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: Circ Cardiovasc Qual Outcomes Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2015 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Médicos / Arterias Carótidas / Estenosis Carotídea / Implantación de Prótesis Vascular / Hospitales de Alto Volumen Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: Circ Cardiovasc Qual Outcomes Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2015 Tipo del documento: Article Pais de publicación: Estados Unidos