FAIMER, Philadelphia, Pennsylvania, USA
American Board of Internal Medicine, Philadelphia, Pennsylvania, USA.
BMJ Open. 2022 Apr 24;12(4):e055558. doi: 10.1136/bmjopen-2021-055558.
To determine whether internists' initial specialty certification and the maintenance of that certification (MOC) is associated with lower in-hospital mortality for their patients with acute myocardial infarction (AMI) or congestive heart failure (CHF).
Retrospective cohort study of hospitalisations in Pennsylvania, USA, from 2012 to 2017.
All hospitals in Pennsylvania.
All 184 115 hospitalisations for primary diagnoses of AMI or CHF where the attending physician was a self-designated internist.
In-hospital mortality.
Of the 2575 physicians, 2238 had initial certification and 820 were eligible for MOC. After controlling for patient demographics and clinical characteristics, hospital-level factors and physicians' demographic and medical school characteristics, both initial certification and MOC were associated with lower mortality. The adjusted OR for initial certification was 0.835 (95% CI 0.756 to 0.922; p<0.001). Patients cared for by physicians with initial certification had a 15.87% decrease in mortality compared with those cared for by non-certified physicians (mortality rate difference of 5.09 per 1000 patients; 95% CI 2.12 to 8.05; p<0.001). The adjusted OR for MOC was 0.804 (95% CI 0.697 to 0.926; p=0.003). Patients cared for by physicians who completed MOC had an 18.91% decrease in mortality compared with those cared for by MOC lapsed physicians (mortality rate difference of 6.22 per 1000 patients; 95% CI 2.0 to 10.4; p=0.004).
Initial certification was associated with lower mortality for AMI or CHF. Moreover, for patients whose physicians had initial certification, an additional advantage was associated with its maintenance.
确定内科医生的初始专业认证及其维持（MOC）是否与急性心肌梗死（AMI）或充血性心力衰竭（CHF）患者的院内死亡率降低有关。
对 2012 年至 2017 年美国宾夕法尼亚州住院治疗的回顾性队列研究。
宾夕法尼亚州的所有医院。
所有被诊断为 AMI 或 CHF 的 184115 例住院患者，主治医生为自报内科医生。
院内死亡率。
在 2575 名医生中，有 2238 名具有初始认证，820 名符合 MOC 条件。在控制患者人口统计学和临床特征、医院级别因素以及医生的人口统计学和医学院特征后，初始认证和 MOC 均与死亡率降低相关。初始认证的调整比值比为 0.835（95%置信区间 0.756 至 0.922；p<0.001）。与未经认证医生相比，接受具有初始认证的医生治疗的患者死亡率降低了 15.87%（死亡率差异为每 1000 名患者 5.09 人；95%置信区间 2.12 至 8.05；p<0.001）。MOC 的调整比值比为 0.804（95%置信区间 0.697 至 0.926；p=0.003）。与 MOC 失效医生相比，接受完成 MOC 医生治疗的患者死亡率降低了 18.91%（死亡率差异为每 1000 名患者 6.22 人；95%置信区间 2.0 至 10.4；p=0.004）。
初始认证与 AMI 或 CHF 的死亡率降低相关。此外，对于其主治医生具有初始认证的患者，其维持与额外的优势相关。
