Journal of General Internal Medicine

, Volume 21, Issue 3, pp 238–244

Physician board certification and the care and outcomes of elderly patients with acute myocardial infarction

  • Jersey Chen
  • Saif S. Rathore
  • Yongfei Wang
  • Martha J. Radford
  • Harlan M. Krumholz
Original Articles

DOI: 10.1111/j.1525-1497.2006.00326.x

Cite this article as:
Chen, J., Rathore, S.S., Wang, Y. et al. J Gen Intern Med (2006) 21: 238. doi:10.1111/j.1525-1497.2006.00326.x

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.

Key words

board certification acute myocardial infarction quality of care mortality 

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Jersey Chen
    • 1
  • Saif S. Rathore
    • 2
  • Yongfei Wang
    • 2
  • Martha J. Radford
    • 2
    • 3
  • Harlan M. Krumholz
    • 2
    • 3
    • 4
    • 5
  1. 1.Beth Israel Deaconess Medical CenterBostonUSA
  2. 2.Section of Cardiovascular Medicine, Department of MedicineYale University School of MedicineNew HavenUSA
  3. 3.Center for Outcomes Research and EvaluationYale New Haven HealthNew HavenUSA
  4. 4.Section of Health Policy and Administration, Department of Epidemiology and Public HealthYale University School of MedicineNew HavenUSA
  5. 5.Robert Wood Johnson Clinical Scholars ProgramYale University School of MedicineNew HavenUSA
  6. 6.the New York University Medical CenterNew York