Physician Board Certification and the Care and Outcomes of Elderly Patients with Acute Myocardial Infarction

Authors

  • Jersey Chen MD, MPH,

    1. Beth Israel Deaconess Medical Center, Boston, MA, USA
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  • Saif S. Rathore MPH,

    1. Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
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  • Yongfei Wang MS,

    1. Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
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  • Martha J. Radford MD,

    1. Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
    2. Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, USA
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  • Harlan M. Krumholz MD, SM

    1. Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
    2. Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, USA
    3. Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA
    4. Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA.
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  • The authors have no conflicts of interest to report.

  • The JGIM Conflict of Interest Disclosure Statement was provided on page 2 of the original submission.

  • Dr. Radford is now with the New York University Medical Center, New York, NY.

Address correspondence and requests for reprints to Dr. Krumholz: Yale University School of Medicine, Room I-456 SHM, 333 Cedar Street, PO Box 208088, New Haven, CT 06520-8088 (e-mail: harlan.krumholz@yale.edu).

Abstract

BACKGROUND: Patients and purchasers prefer board-certified physicians, but whether these physicians provide better quality of care and outcomes for hospitalized patients is unclear.

OBJECTIVE: We evaluated whether care by board-certified physicians after acute myocardial infarction (AMI) was associated with higher use of clinical guideline recommended therapies and lower 30-day mortality.

SUBJECTS AND METHODS: We examined 101,251 Medicare patients hospitalized for AMI in the United States and compared use of aspirin, β-blockers, and 30-day mortality according to the attending physicians' board certification in family practice, internal medicine, or cardiology.

RESULTS: Board-certified family practitioners had slightly higher use of aspirin (admission: 51.1% vs 46.0%; discharge: 72.2% vs 63.9%) and β-blockers (admission: 44.1% vs 37.1%; discharge: 46.2% vs 38.7%) than nonboard-certified family practitioners. There was a similar pattern in board-certified Internists for aspirin (admission: 53.7% vs 49.6%; discharge: 78.2% vs 68.8%) and β-blockers (admission: 48.9% vs 44.1%; discharge: 51.2% vs 47.1). Board-certified cardiologists had higher use of aspirin compared with cardiologists certified in internal medicine only or without any board certification (admission: 61.3% vs 53.1% vs 52.1%; discharge: 82.2% vs 71.8% vs 71.5%) and β-blockers (admission: 52.9% vs 49.6% vs 41.5%; discharge: 54.7% vs 50.6% vs 42.5%). In multivariate regression analyses, board certification was not associated with differences in 30-day mortality.

CONCLUSIONS: Treatment by a board-certified physician was associated with modestly higher quality of care for AMI, but not differences in mortality. Regardless of board certification, all physicians had opportunities to improve quality of care for AMI.

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