Association of Cardiology Billing Amounts With Health Care Utilization and Clinical Outcomes in Patients With Atrial Fibrillation
| Autor: | Zachary Bouck, Shaun G. Goodman, Cherry Chu, Mohammed Shurrab, Dennis T. Ko, R. Sacha Bhatia, Eugene Crystal, A. Kaoutskaia, Peter C. Austin, Bing Yu, Paul Dorian, Heather J. Ross, Kaveh G. Shojania, Jiming Fang |
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| Rok vydání: | 2021 |
| Předmět: |
antiarrhythmia agent
Male medicine.medical_specialty Cost effectiveness Cardiology health services administration Atrial Fibrillation Health care medicine Diseases of the circulatory (Cardiovascular) system Humans In patient cardiovascular diseases health care economics and organizations Original Research Aged Retrospective Studies Ontario Quality and Outcomes business.industry Atrial fibrillation cost‐effectiveness Health Services Patient Acceptance of Health Care outcome and process assessment medicine.disease Electrophysiology Hospitalization RC666-701 Emergency medicine outcome Female Cost-Effectiveness Cardiology and Cardiovascular Medicine business atrial fibrillation arrhythmia Health Services and Outcomes Research |
| Zdroj: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 21 (2021) |
| ISSN: | 2047-9980 |
| DOI: | 10.1161/jaha.120.020708 |
| Popis: | Background The relationship between health care utilization and outcomes in patients with atrial fibrillation is unknown. The objective of this study was to investigate whether cardiologists’ billing amounts in a fee‐for‐service environment are associated with better patient‐level clinical outcomes. Methods and Results A retrospective cohort study was conducted using administrative claims data of cardiologists in Ontario, Canada between April 1, 2011 and March 31, 2016. The cardiologists were stratified into quintiles based on their median billing patterns per patient over the observation period. The primary outcomes were patient‐level receipt of repeat visits, cardiac diagnostic tests, and medications ≤1 year of index date. The secondary clinical outcomes were death, emergency department visits, and all‐cause hospitalization 1‐year post‐index visit. The patient cohort comprised 182 572 patients with atrial fibrillation (median age 74 years, 58% male) from 467 cardiologists. Patients with atrial fibrillation seen by higher‐billing cardiologists were 26% more likely to have an echocardiogram (adjusted odds ratio [aOR], 1.26 [95% CI, 1.10–1.43] for quintile 5 versus 2), 28% a stress test (aOR, 1.28 [1.12–1.46] for quintile 5 versus 2), 25% continuous electrocardiographic monitoring (aOR, 1.25 [1.08–1.46] for quintile 4 versus 2), and 79% more likely to get a stress echocardiogram (aOR, 1.79 [1.32–2.42] for quintile 5 versus 2). They also had a higher rate of all‐cause hospitalization (aOR, 1.13 [1.07–1.20]). Mortality rates were similar across cardiologists billing quintiles (eg, aOR, 0.98 [0.87–1.11] for quintile 4 versus 2). Conclusions Higher‐billing cardiologists ordered more diagnostic tests per patient with atrial fibrillation but these are not associated with improvements in outcomes. |
| Databáze: | OpenAIRE |
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