The association between provider characteristics and post-catheterization interventions

PLoS One. 2022 Apr 1;17(4):e0266544. doi: 10.1371/journal.pone.0266544. eCollection 2022.

Abstract

Objectives: To examine whether the demographics of providers' prior year patient cohorts, providers' historic degree of catheter-based fractional flow reserve (FFR) utilization, and other provider characteristics were associated with post-catheterization performance of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).

Study design: A retrospective, observational analysis of outpatient claims data was performed.

Methods: All 2018 outpatient catheterization claims from a national organization offering commercial and Medicare Advantage health plans were examined. Claims were excluded if the patient had a prior catheterization in 2018, had any indications of CABG or valvular heart disease in the prior year of claims, or if the provider had ≤10 catheterization claims in 2017. Downstream PCI and CABG were determined by examining claims 0-30 days post-catheterization. Using multivariate mixed effects logistic regression with provider identity random effects, the association between post-catheterization procedures and provider characteristics was assessed, controlling for patient characteristics.

Results: The sample consisted of 31,920 catheterization claims pertaining to procedures performed by 964 providers. Among the catheterization claims, 8,554 (26.8%) were followed by PCI and 1,779 (5.6%) were followed by CABG. Catheterizations performed by providers with older prior year patient cohorts were associated with higher adjusted odds of PCI (1.78; CI: 1.26-2.53), even after controlling for patient age. Catheterizations performed by providers with greater historic use of FFR had significantly higher adjusted odds of being followed by PCI (1.73; CI: 1.26-2.37).

Conclusion: Provider characteristics may impact whether patients receive a procedure post-catheterization. Further research is needed to characterize this relationship.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiac Catheterization
  • Coronary Artery Disease*
  • Fractional Flow Reserve, Myocardial*
  • Humans
  • Medicare
  • Percutaneous Coronary Intervention* / methods
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • United States

Grants and funding

Funding for the development of this manuscript was provided by HealthHelp and Humana Inc., in the form of general compensation provided to the authors. The authors were compensated for participation in research activities as a part of their job responsibilities, rather than this particular study.