The association between provider characteristics and post-catheterization interventions

Area of Science:

• Cardiology
• Health Services Research

Background:

• Provider characteristics can influence clinical decision-making for invasive procedures.
• Understanding these influences is crucial for optimizing patient care pathways after cardiac catheterization.

Purpose of the Study:

• To investigate the association between provider characteristics and the performance of post-catheterization percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
• Specifically, to examine the impact of prior year patient demographics and historical fractional flow reserve (FFR) utilization by providers.

Main Methods:

• Retrospective analysis of 31,920 outpatient cardiac catheterization claims from 2018.
• Used multivariate mixed-effects logistic regression to assess associations between provider characteristics and downstream PCI/CABG within 0-30 days.
• Controlled for patient characteristics and provider identity.

Main Results:

• Catheterizations by providers with older patient cohorts showed higher odds of subsequent PCI (OR 1.78).
• Providers with higher historical fractional flow reserve (FFR) utilization had increased odds of performing PCI post-catheterization (OR 1.73).
• 26.8% of catheterizations were followed by PCI and 5.6% by CABG.

Conclusions:

• Provider-specific factors, including patient cohort demographics and FFR utilization patterns, are associated with post-catheterization procedural decisions.
• These findings highlight potential disparities or influences in care delivery that warrant further investigation.