Certification and specialization: do they matter in the outcome of acute myocardial infarction?
J J Norcini1, H R Kimball, R S Lipner
1Institute for Clinical Evaluation, Philadelphia, PA 19106-3699, USA.
Insights
Physician certification and specialization in cardiology are linked to better outcomes for acute myocardial infarction (AMI) patients. Certified physicians reduced AMI mortality by 15%.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Acute myocardial infarction (AMI) is a leading cause of mortality.
- Physician specialization and certification may influence patient outcomes.
Purpose of the Study:
- To compare patient mortality rates among certified and self-designated cardiologists, internists, and family practitioners for patients with AMI.
Main Methods:
- Analysis of patient data for AMI admissions in Pennsylvania during 1993.
- Comparison of physician characteristics (specialty, certification, patient volume, experience) and hospital factors.
- Regression modeling to assess the impact on patient mortality.
Main Results:
- Cardiologists treated more patients with less severe illnesses on average.
- Physician certification was associated with a statistically significant 15% reduction in AMI patient mortality.
- Physician specialty, patient volume, and years since medical school graduation were also significant predictors of mortality.
Conclusions:
- Treatment by certified cardiologists with higher patient volumes and more recent medical education is associated with reduced mortality in AMI patients.
- Physician certification status is a significant factor in improving outcomes for acute myocardial infarction.
Purpose:
To learn whether there are differences among certified and self-designated cardiologists, internists, and family practitioners in terms of the mortality of their patients with acute myocardial infarction (AMI).
Method:
Data on all patients admitted with AMI were collected for calendar year 1993 by the Pennsylvania Health Care Cost Containment Council and analyzed. Certified and self-designated family practitioners, internists, and cardiologists (n = 4,546) were compared with respect to the characteristics of their patients' illnesses. In addition, a regression model was fitted in which mortality was the dependent measure and the independent variables were the probability of death, hospital characteristics (location and the availability of advanced cardiac care), and physician characteristics (patient volume, years since graduation from medical school, specialty, and certification status).
Results:
On average, cardiologists treated more patients than did generalists, and their patients were less severely ill. In the regression analysis, all variables were statistically significant except the availability of advanced cardiac care. Holding all other variables constant, treatment by a certified physician was associated with a 15% reduction in mortality among patients with AMI.
Conclusions:
Less patient mortality was associated with treatment by physicians who were cardiologists, cared for larger numbers of AMI patients, were closer to their graduation from medical school, and were certified.
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