V S Srinivas1, Susan M Hailpern2, Elana Koss3, E Scott Monrad3, Michael H Alderman2. 1. Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, New York. Electronic address: vsriniva@montefiore.org. 2. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York. 3. Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, New York.
Abstract
OBJECTIVES: We sought to examine the combined effect of hospital and physician volume of primary percutaneous coronary intervention (PCI) on in-hospital mortality. BACKGROUND: An inverse relationship between volume and outcome has been observed for both hospitals and physicians after primary PCI for acute myocardial infarction. METHODS: Using the New York State PCI registry, we examined yearly hospital volume, physician volume, and risk-adjusted mortality in 7,321 patients undergoing primary PCI for acute myocardial infarction. Risk-adjusted mortality rates for high-volume hospitals (>50 cases/year) and high-volume physicians (>10 cases/year) were compared with their respective low-volume counterparts. RESULTS: Primary PCI by high-volume hospitals (odds ratio [OR]: 0.58; 95% confidence interval [CI]: 0.38 to 0.88) and high-volume physicians (OR: 0.66; 95% CI: 0.48 to 0.92) was associated with lower odds of mortality. Furthermore, there was a significant interaction between hospital and physician volume on adjusted mortality (p = 0.02). Although unadjusted mortality was lower when primary PCI was performed by high-volume physicians in high-volume hospitals compared with low-volume physicians in low-volume hospitals (3.2% vs. 6.7%, p = 0.03), the risk-adjusted mortality rate was not statistically significant (3.8% vs. 8.4%, p = 0.09). In low-volume hospitals, the average risk-adjusted mortality rate for low-volume physicians was 8.4% versus 4.8% for high-volume physicians (OR: 1.44; 95% CI: 0.68 to 3.03). However, in high-volume hospitals, the risk-adjusted mortality rate for high-volume physicians was 3.8% versus 6.5% for low-volume physicians (OR: 0.58; 95% CI: 0.39 to 0.86). CONCLUSIONS: During primary PCI, physician experience significantly modifies the hospital volume-outcome relationship. Therefore, policymakers need to consider physician experience when developing strategies to improve access to primary PCI.
OBJECTIVES: We sought to examine the combined effect of hospital and physician volume of primary percutaneous coronary intervention (PCI) on in-hospital mortality. BACKGROUND: An inverse relationship between volume and outcome has been observed for both hospitals and physicians after primary PCI for acute myocardial infarction. METHODS: Using the New York State PCI registry, we examined yearly hospital volume, physician volume, and risk-adjusted mortality in 7,321 patients undergoing primary PCI for acute myocardial infarction. Risk-adjusted mortality rates for high-volume hospitals (>50 cases/year) and high-volume physicians (>10 cases/year) were compared with their respective low-volume counterparts. RESULTS: Primary PCI by high-volume hospitals (odds ratio [OR]: 0.58; 95% confidence interval [CI]: 0.38 to 0.88) and high-volume physicians (OR: 0.66; 95% CI: 0.48 to 0.92) was associated with lower odds of mortality. Furthermore, there was a significant interaction between hospital and physician volume on adjusted mortality (p = 0.02). Although unadjusted mortality was lower when primary PCI was performed by high-volume physicians in high-volume hospitals compared with low-volume physicians in low-volume hospitals (3.2% vs. 6.7%, p = 0.03), the risk-adjusted mortality rate was not statistically significant (3.8% vs. 8.4%, p = 0.09). In low-volume hospitals, the average risk-adjusted mortality rate for low-volume physicians was 8.4% versus 4.8% for high-volume physicians (OR: 1.44; 95% CI: 0.68 to 3.03). However, in high-volume hospitals, the risk-adjusted mortality rate for high-volume physicians was 3.8% versus 6.5% for low-volume physicians (OR: 0.58; 95% CI: 0.39 to 0.86). CONCLUSIONS: During primary PCI, physician experience significantly modifies the hospital volume-outcome relationship. Therefore, policymakers need to consider physician experience when developing strategies to improve access to primary PCI.
Authors: Meeta Prasad Kerlin; Andrew Epstein; Jeremy M Kahn; Theodore J Iwashyna; David A Asch; Michael O Harhay; Sarah J Ratcliffe; Scott D Halpern Journal: Ann Am Thorac Soc Date: 2018-03
Authors: Christian Martin-Gill; Christopher P Dilger; Francis X Guyette; Jon C Rittenberger; Clifton W Callaway Journal: Prehosp Emerg Care Date: 2011-04-04 Impact factor: 3.077
Authors: Michael T Cudnik; Comilla Sasson; Thomas D Rea; Michael R Sayre; Jianying Zhang; Bentley J Bobrow; Daniel W Spaite; Bryan McNally; Kurt Denninghoff; Uwe Stolz Journal: Resuscitation Date: 2012-02-19 Impact factor: 5.262
Authors: Avery B Nathens; Antoine Eskander; David Forner; Christopher W Noel; Matthew P Guttman; Barbara Haas; Danny Enepekides; Matthew H Rigby; S Mark Taylor Journal: Eur J Trauma Emerg Surg Date: 2022-03-23 Impact factor: 2.374