An article titled, “The Association between Provider Characteristics and Post-Catheterization Procedures” has been published by PLOS ONE. The study was produced by the ongoing outcomes research collaboration between HealthHelp and Humana, and utilized data provided by the organizations. An abstract related to this study was previously presented at ACC.21, the 2021 Annual Meeting of the American College of Cardiology.
Provider characteristics are observable features that can be used to guide decisions regarding where patients should receive catheterization. One provider characteristic with the potential to impact post-catheterization outcomes is the provider’s propensity to perform catheter-based fractional flow reserve (FFR), a diagnostic technique that enables physicians to measure the pressure difference across stenoses. While several sets of clinical guidelines have provided some endorsement for FFR measurement, it has yet to be incorporated as part of the standard of care. Therefore, there is likely both provider-level variation in use of FFR, and among providers who perform it, variation in the extent to which they do so. Although factors external to the condition of the patient being treated should not influence care, empirical research shows that they do.
The purpose of this study was to assess whether providers’ historic degree of catheter-based fractional flow reserve (FFR) utilization and other provider characteristics were associated with post-catheterization performance of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) surgery. If significant associations are found, further research may be needed to determine whether providers’ historic propensity to perform FFR and the characteristics of providers’ prior patients should be considered when selecting a provider for cardiac catheterization.
All 2018 outpatient catheterization claims from patients with commercial and Medicare Advantage health plans were examined. Claims were excluded if the patient had a prior catheterization in 2018, had any indications of CABG or valvular heart disease in the prior year of claims, or if the provider had ≤10 catheterization claims in 2017. Downstream PCI and CABG were determined by examining claims 0-30 days post-catheterization. Using multivariate mixed effects logistic regression with provider identity random effects, the association between post-catheterization procedures and provider characteristics was assessed, controlling for patient characteristics.
The study analyzed a sample consisting of 31,920 catheterization claims pertaining to procedures performed by 964 providers. Among the catheterization claims, 8,554 (26.8%) were followed by PCI and 1,779 (5.6%) were followed by CABG. Catheterization performed by providers with greater use of FFR had significantly higher odds of being followed by PCI (1.73; CI: 1.26-2.37). Catheterizations performed by providers with older prior year patient cohorts were associated with higher odds of PCI (1.78; CI: 1.26-2.53). The study concluded that provider characteristics may impact whether patients receive a procedure post-catheterization. Further research is needed to characterize this relationship.
In response to the study’s findings, the study’s lead author, Adam C. Powell, Ph.D., remarked, “The findings suggest that the patient’s presentation is one of multiple factors that may impact the care received. We found that the likelihood that a particular patient receives a PCI following catheterization is significantly associated with both the provider’s historic use of FFR and the historic age of the provider’s patient cohort. Differences in the prior clinical experiences of healthcare providers may be one reason that between-provider variation in care has been observed in so many contexts.”
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