PMID- 26646817
OWN - NLM
STAT- MEDLINE
DCOM- 20161019
LR  - 20161230
IS  - 1941-7705 (Electronic)
IS  - 1941-7713 (Linking)
VI  - 9
IP  - 1
DP  - 2016 Jan
TI  - Relationship of Provider and Practice Volume to Performance Measure Adherence for 
      Coronary Artery Disease, Heart Failure, and Atrial Fibrillation: Results From the 
      National Cardiovascular Data Registry.
PG  - 48-54
LID - 10.1161/CIRCOUTCOMES.115.002159 [doi]
AB  - BACKGROUND: There is a reported association between high clinical volume and 
      improved outcomes. Whether this relationship is true for outpatients with 
      coronary artery disease (CAD), heart failure (HF), and atrial fibrillation (AF) 
      remains unknown. METHODS AND RESULTS: Using the PINNACLE Registry (2009-2012), 
      average monthly provider and practice volumes were calculated for CAD, HF, and 
      AF. Adherence with 4 American Heart Association CAD, 2 HF, and 1 AF performance 
      measure were assessed at the most recent encounter for each patient. Hierarchical 
      logistic regression models were used to assess the relationship between provider 
      and practice volume and performance on eligible quality measures. Data 
      incorporated patients from 1094 providers at 71 practices (practice level 
      analyses n=654 535; provider level analyses n=529 938). Median monthly provider 
      volumes were 79 (interquartile range [IQR], 51-117) for CAD, 27 (16-45) for HF, 
      and 37 (24-54) for AF. Median monthly practice volumes were 923 (IQR, 476-1455) 
      for CAD, 311 (145-657) for HF, and 459 (185-720) for AF. Overall, 55% of patients 
      met all CAD measures, 72% met all HF measures, and 58% met the AF measure. There 
      was no definite relationship between practice volume and concordance for CAD, AF, 
      or HF (P=0.56, 0.52, and 0.79, respectively). In contrast, higher provider volume 
      was associated with increased concordance for CAD and AF performance measures 
      (P<0.001 for both), but not for HF (P=0.36). CONCLUSIONS: In the PINNACLE 
      registry, performance was modest and variable. Higher provider volume was 
      positively associated with quality, whereas practice volume was not.
CI  - (c) 2015 American Heart Association, Inc.
FAU - Fleming, Lisa M
AU  - Fleming LM
AD  - From the Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 
      (L.M.F.); Saint Luke's Mid-America Institute, Kansas City, MO (P.J., P.S.C.); 
      Department of Medicine, University of Missouri, Kansas City (P.C., P.J.); 
      Northwestern University, Department of Surgery, Chicago, IL (A.-C.A.); Veterans 
      Affairs Eastern Colorado Health Care System, University of Colorado, Denver 
      (T.M.M.); and Office of Clinical Practice Innovation, George Washington 
      University, Washington, DC (S.A.F.). Lisa.fleming04@gmail.com.
FAU - Jones, Philip
AU  - Jones P
AD  - From the Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 
      (L.M.F.); Saint Luke's Mid-America Institute, Kansas City, MO (P.J., P.S.C.); 
      Department of Medicine, University of Missouri, Kansas City (P.C., P.J.); 
      Northwestern University, Department of Surgery, Chicago, IL (A.-C.A.); Veterans 
      Affairs Eastern Colorado Health Care System, University of Colorado, Denver 
      (T.M.M.); and Office of Clinical Practice Innovation, George Washington 
      University, Washington, DC (S.A.F.).
FAU - Chan, Paul S
AU  - Chan PS
AD  - From the Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 
      (L.M.F.); Saint Luke's Mid-America Institute, Kansas City, MO (P.J., P.S.C.); 
      Department of Medicine, University of Missouri, Kansas City (P.C., P.J.); 
      Northwestern University, Department of Surgery, Chicago, IL (A.-C.A.); Veterans 
      Affairs Eastern Colorado Health Care System, University of Colorado, Denver 
      (T.M.M.); and Office of Clinical Practice Innovation, George Washington 
      University, Washington, DC (S.A.F.).
FAU - Andrei, Adin-Christian
AU  - Andrei AC
AD  - From the Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 
      (L.M.F.); Saint Luke's Mid-America Institute, Kansas City, MO (P.J., P.S.C.); 
      Department of Medicine, University of Missouri, Kansas City (P.C., P.J.); 
      Northwestern University, Department of Surgery, Chicago, IL (A.-C.A.); Veterans 
      Affairs Eastern Colorado Health Care System, University of Colorado, Denver 
      (T.M.M.); and Office of Clinical Practice Innovation, George Washington 
      University, Washington, DC (S.A.F.).
FAU - Maddox, Thomas M
AU  - Maddox TM
AD  - From the Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 
      (L.M.F.); Saint Luke's Mid-America Institute, Kansas City, MO (P.J., P.S.C.); 
      Department of Medicine, University of Missouri, Kansas City (P.C., P.J.); 
      Northwestern University, Department of Surgery, Chicago, IL (A.-C.A.); Veterans 
      Affairs Eastern Colorado Health Care System, University of Colorado, Denver 
      (T.M.M.); and Office of Clinical Practice Innovation, George Washington 
      University, Washington, DC (S.A.F.).
FAU - Farmer, Steven A
AU  - Farmer SA
AD  - From the Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 
      (L.M.F.); Saint Luke's Mid-America Institute, Kansas City, MO (P.J., P.S.C.); 
      Department of Medicine, University of Missouri, Kansas City (P.C., P.J.); 
      Northwestern University, Department of Surgery, Chicago, IL (A.-C.A.); Veterans 
      Affairs Eastern Colorado Health Care System, University of Colorado, Denver 
      (T.M.M.); and Office of Clinical Practice Innovation, George Washington 
      University, Washington, DC (S.A.F.).
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20151208
PL  - United States
TA  - Circ Cardiovasc Qual Outcomes
JT  - Circulation. Cardiovascular quality and outcomes
JID - 101489148
RN  - 0 (Cardiovascular Agents)
SB  - IM
MH  - Aged
MH  - Atrial Fibrillation/*drug therapy/epidemiology
MH  - Cardiology/*standards
MH  - Cardiovascular Agents/therapeutic use
MH  - Coronary Artery Disease/*drug therapy/epidemiology
MH  - Female
MH  - *Guideline Adherence
MH  - Heart Failure/*drug therapy/epidemiology
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Practice Guidelines as Topic
MH  - Practice Patterns, Physicians'/*statistics & numerical data
MH  - Quality Assurance, Health Care
MH  - Quality Improvement
MH  - Registries
MH  - United States/epidemiology
MH  - *Workload
OTO - NOTNLM
OT  - United States
OT  - atrial fibrillation
OT  - coronary artery disease
OT  - heart failure
OT  - outpatients
EDAT- 2015/12/10 06:00
MHDA- 2016/11/12 06:00
CRDT- 2015/12/10 06:00
PHST- 2015/07/09 00:00 [received]
PHST- 2015/10/26 00:00 [accepted]
PHST- 2015/12/10 06:00 [entrez]
PHST- 2015/12/10 06:00 [pubmed]
PHST- 2016/11/12 06:00 [medline]
AID - CIRCOUTCOMES.115.002159 [pii]
AID - 10.1161/CIRCOUTCOMES.115.002159 [doi]
PST - ppublish
SO  - Circ Cardiovasc Qual Outcomes. 2016 Jan;9(1):48-54. doi: 
      10.1161/CIRCOUTCOMES.115.002159. Epub 2015 Dec 8.