Paul N Fiorilli1, Karl E Minges1, Jeph Herrin1, John C Messenger1, Henry H Ting1, Brahmajee K Nallamothu1, Rebecca S Lipner1, Brian J Hess1, Eric S Holmboe1, Joseph J Brennan1, Jeptha P Curtis2. 1. From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.). 2. From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.). jeptha.curtis@yale.edu.
Abstract
BACKGROUND: The value of American Board of Internal Medicine certification has been questioned. We evaluated the Association of Interventional Cardiology certification with in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) in 2010. METHODS AND RESULTS: We identified physicians who performed ≥10 PCIs in 2010 in the CathPCI Registry and determined interventional cardiology (ICARD) certification status using American Board of Internal Medicine data. We compared in-hospital outcomes of patients treated by certified and noncertified physicians using hierarchical multivariable models adjusted for differences in patient characteristics and PCI volume. Primary end points were all-cause in-hospital mortality and bleeding complications. Secondary end points included emergency coronary artery bypass grafting, vascular complications, and a composite of any adverse outcome. With 510,708 PCI procedures performed by 5175 physicians, case mix and unadjusted outcomes were similar among certified and noncertified physicians. The adjusted risks of in-hospital mortality (odds ratio, 1.10; 95% confidence interval, 1.02-1.19) and emergency coronary artery bypass grafting (odds ratio, 1.32; 95% confidence interval, 1.12-1.56) were higher in the non-ICARD-certified group, but the risks of bleeding and vascular complications and the composite end point were not statistically significantly different between groups. CONCLUSIONS: We did not observe a consistent association between ICARD certification and the outcomes of PCI procedures. Although there was a significantly higher risk of mortality and emergency coronary artery bypass grafting in patients treated by non-ICARD-certified physicians, the risks of vascular complications and bleeding were similar. Our findings suggest that ICARD certification status alone is not a strong predictor of patient outcomes and indicate a need to enhance the value of subspecialty certification.
BACKGROUND: The value of American Board of Internal Medicine certification has been questioned. We evaluated the Association of Interventional Cardiology certification with in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) in 2010. METHODS AND RESULTS: We identified physicians who performed ≥10 PCIs in 2010 in the CathPCI Registry and determined interventional cardiology (ICARD) certification status using American Board of Internal Medicine data. We compared in-hospital outcomes of patients treated by certified and noncertified physicians using hierarchical multivariable models adjusted for differences in patient characteristics and PCI volume. Primary end points were all-cause in-hospital mortality and bleeding complications. Secondary end points included emergency coronary artery bypass grafting, vascular complications, and a composite of any adverse outcome. With 510,708 PCI procedures performed by 5175 physicians, case mix and unadjusted outcomes were similar among certified and noncertified physicians. The adjusted risks of in-hospital mortality (odds ratio, 1.10; 95% confidence interval, 1.02-1.19) and emergency coronary artery bypass grafting (odds ratio, 1.32; 95% confidence interval, 1.12-1.56) were higher in the non-ICARD-certified group, but the risks of bleeding and vascular complications and the composite end point were not statistically significantly different between groups. CONCLUSIONS: We did not observe a consistent association between ICARD certification and the outcomes of PCI procedures. Although there was a significantly higher risk of mortality and emergency coronary artery bypass grafting in patients treated by non-ICARD-certified physicians, the risks of vascular complications and bleeding were similar. Our findings suggest that ICARD certification status alone is not a strong predictor of patient outcomes and indicate a need to enhance the value of subspecialty certification.
Authors: Rebecca S Lipner; John C Messenger; Roberta Kangilaski; Donald S Baim; David R Holmes; David O Williams; Spencer B King Journal: Simul Healthc Date: 2010-04 Impact factor: 1.929
Authors: R J Glassock; J A Benson; R B Copeland; H A Godwin; W G Johanson; W Point; R L Popp; L Scherr; J H Stein; O D Taunton Journal: Ann Intern Med Date: 1991-01-01 Impact factor: 25.391
Authors: Paul S Chan; Manesh R Patel; Lloyd W Klein; Ronald J Krone; Gregory J Dehmer; Kevin Kennedy; Brahmajee K Nallamothu; W Douglas Weaver; Frederick A Masoudi; John S Rumsfeld; Ralph G Brindis; John A Spertus Journal: JAMA Date: 2011-07-06 Impact factor: 56.272
Authors: John C Messenger; Kalon K L Ho; Christopher H Young; Lara E Slattery; Jasmine C Draoui; Jeptha P Curtis; Gregory J Dehmer; Frederick L Grover; Michael J Mirro; Matthew R Reynolds; Ivan C Rokos; John A Spertus; Tracy Y Wang; Stuart A Winston; John S Rumsfeld; Frederick A Masoudi Journal: J Am Coll Cardiol Date: 2012-09-19 Impact factor: 24.094
Authors: Manesh R Patel; Gregory J Dehmer; John W Hirshfeld; Peter K Smith; John A Spertus Journal: J Am Coll Cardiol Date: 2012-01-30 Impact factor: 24.094
Authors: Manesh R Patel; Gregory J Dehmer; John W Hirshfeld; Peter K Smith; John A Spertus Journal: J Am Coll Cardiol Date: 2009-02-10 Impact factor: 24.094
Authors: Daniel M Blumenthal; Andrew R Olenski; Robert W Yeh; Doreen DeFaria Yeh; Amy Sarma; Ada C Stefanescu Schmidt; Malissa J Wood; Anupam B Jena Journal: Circulation Date: 2017-02-07 Impact factor: 29.690
Authors: Furman S McDonald; Lauren M Duhigg; Gerald K Arnold; Ruth M Hafer; Rebecca S Lipner Journal: J Gen Intern Med Date: 2018-03-07 Impact factor: 5.128
Authors: Chad Stecher; Alexander Everhart; Laura Barrie Smith; Anupam Jena; Joseph S Ross; Nihar R Desai; Nilay Shah; Pinar Karaca-Mandic Journal: Circ Cardiovasc Qual Outcomes Date: 2021-09-24
Authors: Sameed Ahmed M Khatana; Paul N Fiorilli; Ashwin S Nathan; Daniel M Kolansky; Nandita Mitra; Peter W Groeneveld; Jay Giri Journal: Circ Cardiovasc Interv Date: 2018-09 Impact factor: 6.546