Abstract
BACKGROUND: Patients and purchasers prefer board-certified physicians, but whether these physicians provide better quality of care and outcomes for hospitalized patients is unclear.
OBJECTIVE: We evaluated whether care by board-certified physicians after acute myocardial infarction (AMI) was associated with higher use of clinical guideline recommended therapies and lower 30-day mortality.
SUBJECTS AND METHODS: We examined 101,251 Medicare patients hospitalized for AMI in the United States and compared use of aspirin, β-blockers, and 30-day mortality according to the attending physicians’ board certification in family practice, internal medicine, or cardiology.
RESULTS: Board-certified family practitioners had slightly higher use of aspirin (admission: 51.1% vs 46.0%; discharge: 72.2% vs 63.9%) and β-blockers (admission: 44.1% vs 37.1%; discharge: 46.2% vs 38.7%) than nonboard-certified family practitioners. There was a similar pattern in board-certified Internists for aspirin (admission: 53.7% vs 49.6%; discharge: 78.2% vs 68.8%) and β-blockers (admission: 48.9% vs 44.1%; discharge: 51.2% vs 47.1). Board-certified cardiologists had higher use of aspirin compared with cardiologists certified in internal medicine only or without any board certification (admission: 61.3% vs 53.1% vs 52.1%; discharge: 82.2% vs 71.8% vs 71.5%) and β-blockers (admission: 52.9% vs 49.6% vs 41.5%; discharge: 54.7% vs 50.6% vs 42.5%). In multivariate regression analyses, board certification was not associated with differences in 30-day mortality.
CONCLUSIONS: Treatment by a board-certified physician was associated with modestly higher quality of care for AMI, but not differences in mortality. Regardless of board certification, all physicians had opportunities to improve quality of care for AMI.
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References
Smith JJ. Legal implications of specialty board certification. J Leg Med. 1996;17:73–111.
Gold MR, Hurley R, Lake T, Ensor T, Berenson R. A national survey of the arrangements managed-care plans make with physicians. N Engl J Med. 1995;333:1678–83.
Jacobs MO, Mott PD. Physician characteristics and training emphasis considered desirable by leaders of HMOs. J Med Educ. 1987;62:725–31.
McIlrath S. Board-certified only need apply. American Medical News. 1994;1, 47–9.
Gramling A. Health plans want to know: are you certified? Manag Care. 1994;3:39–41.
Brennan TA, Horwitz RI, Duffy FD, Cassel CK, Goode LD, Lipner RS. The role of physician specialty board certification status in the quality movement. JAMA. 2004;292:1038–43.
Benson JA Jr. Certification and recertification: one approach to professional accountability. Ann Intern Med. 1991;114:238–42.
Cassel CK. The quality crescendo. Perspectives. American Board of Internal Medicine Newsletter for Diplomates. 1999: 1, 4, 5, 12.
American Medical Association. Physician Characteristics and Distribution in the US. 2004 Edn. Chicago, IL: AMA Press; 2004.
Sharp LK, Bashook PG, Lipsky MS, Horowitz SD, Miller SH. Specialty board certification and clinical outcomes: the missing link. Acad Med. 2002;77:534–42.
Ramsey PG, Carline JD, Inui TS, Larson EB, LoGerfo JP, Wenrich MD. Predictive validity of certification by the American Board of Internal Medicine. Ann Intern Med. 1989;110:719–26.
Tamblyn R, Abrahamowicz M, Dauphinee WD, et al. Association between licensure examination scores and practice in primary care. JAMA. 2002;288:3019–26.
Marciniak TA, Ellerbeck EF, Radford MJ, et al. Improving the quality of care for Medicare patients with acute myocardial infarction: results from the Cooperative Cardiovascular Project. JAMA. 1998;279:1351–7.
Ryan TJ, Anderson JK, Antman EM, et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol. 1996;28:1328–428.
Baldwin LM, Adamache W, Klabunde CN, Kenward K, Dahlman C, Warren JL. Linking physician characteristics and Medicare claims data: issues in data availability, quality, and measurement. Med Care. 2002;40:82–95.
Cherkin D, Lawrence D. An evaluation of the American Medical Association’s Physician Masterfile as a data source—one state’s experience. Med Care. 1977;15:767–9.
Iezzoni LI. Data sources and implications: administrative data bases. In: Iezzoni LI, ed. Risk Adjustment for Measuring Health Outcomes. Ann Arbor: Health Administration Press; 1994:122–75.
American Hospital Association. The Annual Survey of Hospitals Database: Documentation for 1994 Data. Chicago, IL: American Hospital Association; 1994.
Ellerbeck EF, Jencks SF, Radford MJ, et al. Quality of care for Medicare patients with acute myocardial infarction: a four-state pilot study from the Cooperative Cardiovascular Project. JAMA. 1995;273:1509–14.
Wentworth DN, Neaton JD, Rasmussen WL. An evaluation of the Social Security Administration master beneficiary record file and the National Death Index in the ascertainment of vital status. Am J Public Health. 1983;73:1270–4.
DeLong E. Hierarchical modeling: its time has come. Am Heart J. 2003;145:16–8.
Lee KL, Woodlief LH, Topol EJ, et al. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. GUSTO-I investigators. Circulation. 1995;91:1659–68.
Chen J, Radford MJ, Wang Y, Krumholz HM. Care and outcomes of elderly patients with acute myocardial infarction by physician specialty: the effects of comorbidity and functional limitations. Am J Med. 2000;108:460–9.
Zhang J, Yu KF. What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280:1690–1.
Cabana MD, Rand CS, Powe NR, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458–65.
Gemson DH, Elinson J. Prevention in primary care: variability in physician practice patterns in New York City. Am J Prev Med. 1986;2:226–34.
Norcini JJ, Webster GD, Grosso LJ, Blank LL, Benson JA Jr. Ratings of residents’ clinical competence and performance on certification examination. J Med Educ. 1987;62:457–62.
Haber RJ, Avins AL. Do ratings on the American Board of Internal Medicine Resident Evaluation Form detect differences in clinical competence? J Gen Intern Med. 1994;9:140–5.
Shea JA, Norcini JJ, Kimball HR. Relationships of ratings of clinical competence and ABIM scores to certification status. Acad Med. 1993;68:S22-S24.
ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet. 1988;2:349–60.
Beta-Blocker Heart Attack Trial (BHAT). A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA. 1982;247:1707–14.
Norcini JJ, Kimball HR, Lipner RS. Certification and specialization: do they matter in the outcome of acute myocardial infarction? Acad Med. 2000;75:1193–8.
Jencks SF, Huff ED, Cuerdon T. Change in the quality of care delivered to Medicare beneficiaries, 1998–1999 to 2000–2001. JAMA. 2003;289:305–12.
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The authors have no conflicts of interest to report.
The JGIM Conflict of Interest Disclosure Statement was provided on page 2 of the original submission.
Dr. Radford is now with the New York University Medical Center, New York, NY.
The analyses upon which this publication is based were performed under Contract Number 500-99-CTO1, entitled, “Utilization and Quality Control Peer Review Organization for the State of Connecticut,” sponsored by the CMS, U.S. Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the U.S. Department of Health and Human Services, nor does mention of trade names, commercial products, or organization imply endorsement by the U.S. Government. The author assumes full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this Contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed.
Mr. Rathore is supported by NIH/National Institute of General Medical Sciences Medical Scientist Training Grant GM07205.
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Chen, J., Rathore, S.S., Wang, Y. et al. Physician board certification and the care and outcomes of elderly patients with acute myocardial infarction. J Gen Intern Med 21, 238–244 (2006). https://doi.org/10.1111/j.1525-1497.2006.00326.x
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DOI: https://doi.org/10.1111/j.1525-1497.2006.00326.x