Skip to main content

Relationship between physician and hospital coronary angioplasty volume and outcome in elderly patients.

Publication ,  Journal Article
Jollis, JG; Peterson, ED; Nelson, CL; Stafford, JA; DeLong, ER; Muhlbaier, LH; Mark, DB
Published in: Circulation
June 3, 1997

BACKGROUND: With the expectation that physicians who perform larger numbers of coronary angioplasty procedures will have better outcomes, the American College of Cardiology/ American Heart Association guidelines recommend minimum physician volumes of 75 procedures per year. However, there is little empirical data to support this recommendation. METHODS AND RESULTS: We examined in-hospital bypass surgery and death after angioplasty according to 1992 physician and hospital Medicare procedure volume. In 1992, 6115 physicians performed angioplasty on 97,478 Medicare patients at 984 hospitals. The median numbers of procedures performed per physician and per hospital were 13 (interquartile range, 5 to 25) and 98 (interquartile range, 40 to 181), respectively. With the assumption that Medicare patients composed one half to one third of all patients undergoing angioplasty, these median values are consistent with an overall physician volume of 26 to 39 cases per year and an overall hospital volume of 196 to 294 cases per year. After adjusting for age, sex, race, acute myocardial infarction, and comorbidity, low-volume physicians were associated with higher rates of bypass surgery (P < .001) and low-volume hospitals were associated with higher rates of bypass surgery and death (P < .001). Improving outcomes were seen up to threshold values of 75 Medicare cases per physician and 200 Medicare cases per hospital. CONCLUSIONS: More than 50% of physicians and 25% of hospitals performing coronary angioplasty in 1992 were unlikely to have met the minimum volume guidelines first published in 1988, and these patients had worse outcomes. While more recent data are required to determine whether the same relationships persist after the introduction of newer technologies, this study suggests that adherence to minimum volume standards by physicians and hospitals will lead to better outcomes for elderly patients undergoing coronary angioplasty.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Circulation

DOI

ISSN

0009-7322

Publication Date

June 3, 1997

Volume

95

Issue

11

Start / End Page

2485 / 2491

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Quality of Health Care
  • Medicare
  • Male
  • Humans
  • Hospital Records
  • Female
  • Coronary Artery Bypass
  • Clinical Competence
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Jollis, J. G., Peterson, E. D., Nelson, C. L., Stafford, J. A., DeLong, E. R., Muhlbaier, L. H., & Mark, D. B. (1997). Relationship between physician and hospital coronary angioplasty volume and outcome in elderly patients. Circulation, 95(11), 2485–2491. https://doi.org/10.1161/01.cir.95.11.2485
Jollis, J. G., E. D. Peterson, C. L. Nelson, J. A. Stafford, E. R. DeLong, L. H. Muhlbaier, and D. B. Mark. “Relationship between physician and hospital coronary angioplasty volume and outcome in elderly patients.Circulation 95, no. 11 (June 3, 1997): 2485–91. https://doi.org/10.1161/01.cir.95.11.2485.
Jollis JG, Peterson ED, Nelson CL, Stafford JA, DeLong ER, Muhlbaier LH, et al. Relationship between physician and hospital coronary angioplasty volume and outcome in elderly patients. Circulation. 1997 Jun 3;95(11):2485–91.
Jollis, J. G., et al. “Relationship between physician and hospital coronary angioplasty volume and outcome in elderly patients.Circulation, vol. 95, no. 11, June 1997, pp. 2485–91. Pubmed, doi:10.1161/01.cir.95.11.2485.
Jollis JG, Peterson ED, Nelson CL, Stafford JA, DeLong ER, Muhlbaier LH, Mark DB. Relationship between physician and hospital coronary angioplasty volume and outcome in elderly patients. Circulation. 1997 Jun 3;95(11):2485–2491.

Published In

Circulation

DOI

ISSN

0009-7322

Publication Date

June 3, 1997

Volume

95

Issue

11

Start / End Page

2485 / 2491

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Quality of Health Care
  • Medicare
  • Male
  • Humans
  • Hospital Records
  • Female
  • Coronary Artery Bypass
  • Clinical Competence