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Related Experiment Videos

Cardiologists performing peripheral angioplasties: impact on utilization.

D A Axelrod1, A M Fendrick, J D Birkmeyer

  • 1Robert Wood Johnson Clinical Scholars Program, University of Michigan Medical Center, Ann Arbor, Mich., USA. davaxe@umich.edu

Effective Clinical Practice : ECP
|November 1, 2001
PubMed
Summary

Cardiologists now perform a significant number of peripheral angioplasties. Higher rates of these procedures are observed in geographic areas where cardiologists conduct most angioplasties.

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Health Services Research

Background:

  • Peripheral arterial occlusive disease interventions traditionally performed by radiologists and surgeons.
  • Increasing involvement of cardiologists in peripheral angioplasty procedures.
  • Uncertainty regarding the impact of cardiologist participation on procedure volume.

Purpose of the Study:

  • To examine the relationship between the proportion of peripheral angioplasties performed by cardiologists and population-based angioplasty rates.
  • To assess geographic variations in peripheral angioplasty utilization.
  • To understand the role of interventional cardiologists in peripheral vascular interventions.

Main Methods:

  • Cross-sectional analysis of U.S. Medicare beneficiaries undergoing peripheral angioplasty in 1996.

Related Experiment Videos

  • Utilized physician claims data for cardiovascular procedures and physician specialty information.
  • Calculated procedure rates and the proportion performed by cardiologists across 306 U.S. hospital referral regions (HRRs).

    • Main Results:

    • Over 37,000 peripheral angioplasties were performed; cardiologists accounted for 26% overall and 37% of renal angioplasties.
    • Significant geographic variation in peripheral angioplasty use (14-fold range).
    • HRRs with ≥50% cardiologist involvement showed nearly double the angioplasty rates compared to those with no cardiologist involvement (21.9 vs. 12.1 per 10,000 beneficiaries; P < 0.001).

    Conclusions:

    • Cardiologists are performing a substantial volume of peripheral angioplasty procedures.
    • Peripheral angioplasty utilization rates are highest in regions with greater cardiologist participation.
    • Findings suggest a significant impact of cardiologist involvement on the accessibility and volume of peripheral angioplasty.