Nallamothu Brahmajee K, Lu Mingrui, Rogers Mary A M, Gurm Hitinder S, Birkmeyer John D
VA Health Services Research and Department of Internal Medicine, Health Services Research and Development Center of Excellence, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0022, USA.
Arch Intern Med. 2011 Nov 14;171(20):1804-10. doi: 10.1001/archinternmed.2011.354. Epub 2011 Aug 8.
The use of carotid stenting is rising across the United States. How physician specialty relates to its utilization rates or outcomes is uncertain.
We performed an observational analysis of fee-for-service Medicare beneficiaries 65 years or older undergoing carotid stenting between 2005 and 2007 in 306 hospital referral regions (HRRs). We first determined how frequently carotid stenting was performed by different specialists within each HRR and then used multivariable regression models to compare population-based utilization rates and 30-day outcomes for this procedure across HRRs based on the proportion performed by cardiologists, surgeons, radiologists, or a mix of specialists.
In 272 HRRs where at least 15 procedures were performed during the study period, we identified 28 700 carotid stenting procedures performed by 2588 operators. While cardiologists made up approximately one-third of these operators, they were responsible for 14 919 (52.0%) procedures. Significant differences were noted in the characteristics of patients treated by cardiologists compared with other specialties, including higher rates of invasive cardiac procedures and lower rates of acute stroke or transient ischemic attacks in the 180 days prior to carotid stenting. Population-based utilization rates were significantly higher in HRRs where cardiologists performed most procedures relative to HRRs where most were done by other specialists or a mix of specialists (P < .001). In contrast, risk-standardized outcomes did not differ across HRRs based on physician specialty.
Carotid stenting is being performed by operators from diverse specialties. Hospital referral regions where cardiologists perform most procedures have higher population-based utilization rates with similar outcomes.
在美国，颈动脉支架置入术的使用正在增加。医生专业与该手术的利用率或结果之间的关系尚不确定。
我们对2005年至2007年期间在306个医院转诊地区（HRR）接受颈动脉支架置入术的65岁及以上按服务收费的医疗保险受益人进行了观察性分析。我们首先确定了每个HRR内不同专科医生进行颈动脉支架置入术的频率，然后使用多变量回归模型，根据心脏病专家、外科医生、放射科医生或专科医生组合进行手术的比例，比较各HRR中该手术基于人群的利用率和30天结果。
在研究期间至少进行了15例手术的272个HRR中，我们确定了由2588名操作者进行的28700例颈动脉支架置入术。虽然心脏病专家约占这些操作者的三分之一，但他们负责14919例（52.0%）手术。与其他专科相比，心脏病专家治疗的患者特征存在显著差异，包括侵入性心脏手术的发生率较高，以及在颈动脉支架置入术前180天内急性中风或短暂性脑缺血发作的发生率较低。与大多数手术由其他专科医生或专科医生组合进行的HRR相比，心脏病专家进行大多数手术的HRR中基于人群的利用率显著更高（P <.001）。相比之下，基于风险标准化的结果在不同HRR之间并未因医生专业而有所不同。
颈动脉支架置入术由不同专科的操作者进行。心脏病专家进行大多数手术的医院转诊地区基于人群的利用率较高，且结果相似。
