A poster titled, “The Association between Provider Characteristics and Post-Catheterization Procedures” has been presented at ACC.21, the American College of Cardiology’s 70th Annual Scientific Session & Expo, which was held virtually from May 15th to 17th. The study was produced by the ongoing outcomes research collaboration between HealthHelp and Humana, and utilized data provided by the organizations.
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, 1,779 (5.6%) were followed by CABG, and 10,197 (31.9%) were followed by either procedure. 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) or either procedure (1.61; CI: 1.20-2.15). Catheterizations performed by providers with older prior year patient cohorts were associated with higher odds of PCI (1.78; CI: 1.26-2.53) and either procedure (1.99; CI: 1.44-2.75). 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 of this study suggest that the care that a patient receives may not be determined by the patient in isolation, but may instead be influenced by the patients that their provider has treated in the past. While other researchers have shown evidence of this relationship in other contexts, our study helps to do so in the context of cardiac catheterization. Differences in providers’ histories may be one reason that we have seen between-provider variation in care for so many conditions.”
To learn more about ACC.21, visit https://accscientificsession.acc.org/