Comparing physician-specific two-year patient outcomes after coronary angiography : Methodologic issues and results.
OBJECTIVES We sought to evaluate methodologies to compare physician-related long-term patient outcomes appropriately.
BACKGROUND Evaluation of physicians on the basis of short-term patient outcome is becoming widely practiced.
These analyses fail to consider the importance of long-term outcome, and methods appropriate to such an analysis are poorly defined.
METHODS All patients undergoing coronary angiography between 1992 and 1994 who received all of their cardiac care at our institution were followed for 27 ± 13 months (mean ± SD).
Patients (n=754) were cared for by one or more of 17 staff physicians.
Risk-adjusted models were developed for four candidate clinical end points and cost.
Physicians were then evaluated for each outcome measure.
RESULTS Of the clinical end points, death could be modeled most accurately (c-statistic=0.83).
The c-statistics for other end points ranged from 0.63 to 0.70.
Physicians with outcomes statistically different (p<0.05) from other physicians were identified more commonly than would be expected from the play of chance (p=0.005).
However, improvement in the c-statistics by the addition of physician identifiers was very modest.
Physician's evaluations by the four measures of clinical outcome were variably correlated (r=00 to. 85).
Graphic display of clinical and cost results for each physician did identify certain physicians who might be judged to provide more cost-effective care than others. (...)
Mots-clés Pascal : Coronarographie, Homme, Médecin, Evolution, Etude comparative, Pronostic, Soin, Long terme, Pratique professionnelle, Assurance qualité, Exploration, Traitement, Cardiopathie coronaire, Radiodiagnostic, Appareil circulatoire pathologie
Mots-clés Pascal anglais : Coronary arteriography, Human, Physician, Evolution, Comparative study, Prognosis, Care, Long term, Professional practice, Quality assurance, Exploration, Treatment, Coronary heart disease, Radiodiagnosis, Cardiovascular disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0370442
Code Inist : 002B12A03. Création : 14/12/1999.