Physician and patient influences on provider performance: β-blockers in postmyocardial infarction management in the MI-Plus study.


BACKGROUND:Efforts to improve the quality of care for patients with cardiovascular disease frequently target the decrease of physician-level performance variability. We assessed how variability in providing β-blockers to ambulatory postmyocardial infarction (MI) patients was influenced by physician and patient level characteristics. METHODS AND RESULTS:β-Blocker prescription and patient characteristics were abstracted from charts of post-MI patients treated by 133 primary care physicians between 2003 and 2007 and linked to physician and practice characteristics. Associations of β-blocker prescription with physician- and patient-level characteristics were examined using mixed-effects models, with physician-level effects as random. Mean physician-specific predicted probabilities and the intraclass correlations, which assessed the proportion of variance explainable at the physician level, were estimated. Of 1901 patients without major contraindication, 69.1% (range across physicians, 20% to 100%) were prescribed β-blockers. Prescription varied with comorbidity from 78.3% in patients with chronic kidney disease to 54.7% for patients with stroke. Although physician characteristics such as older physician age, group practice, and rural location were each positively associated with β-blocker prescription, physician factors accounted for only 5% to 8% of the variance in β-blocker prescription; the preponderance of the variance, 92% to 95%, was at the patient level. The mean physician-specific probability of β-blocker prescription (95% confidence interval) in the fully adjusted model was 63% (61% to 65%). CONCLUSIONS:β-Blocker prescription rates were surprisingly low. The contribution of physician factors to overall variability in β-blocker prescription, however, was limited. Increasing evidence-based use of β-blockers may not be accomplished by focusing mostly on differential performance across physicians.


Funkhouser E,Houston TK,Levine DA,Richman J,Allison JJ,Kiefe CI




Has Abstract


2011-01-01 00:00:00














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    abstract:BACKGROUND:Percent time in therapeutic range (TTR) and international normalized ratio (INR) variability both measure warfarin control and are associated with outcomes independently. Here, we examine the advantages of a warfarin composite measure (WCM), which summarizes the 2 when measuring patient outcomes. We also exa...

    journal_title:Circulation. Cardiovascular quality and outcomes

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    更新日期:2015-11-01 00:00:00

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    abstract:BACKGROUND:Implementation of stroke early supported discharge (ESD) services has been recommended in many countries' clinical guidelines, based on clinical trial evidence. This is the first observational study to investigate the effectiveness of ESD service models operating in real-world conditions, at scale. METHODS ...

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    更新日期:2020-08-01 00:00:00

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    更新日期:2015-01-01 00:00:00

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    更新日期:2018-09-01 00:00:00

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    pub_type: 杂志文章,多中心研究,随机对照试验


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    更新日期:2009-07-01 00:00:00

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    journal_title:Circulation. Cardiovascular quality and outcomes

    pub_type: 杂志文章


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    更新日期:2011-09-01 00:00:00

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    pub_type: 杂志文章


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    更新日期:2015-10-01 00:00:00

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    更新日期:2017-02-01 00:00:00

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    更新日期:2021-01-01 00:00:00

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    更新日期:2013-11-01 00:00:00

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    journal_title:Circulation. Cardiovascular quality and outcomes

    pub_type: 杂志文章,多中心研究,随机对照试验


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    authors: Borzecki AM,Chen Q,Mull HJ,Shwartz M,Bhatt DL,Hanchate A,Rosen AK

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    更新日期:2009-11-01 00:00:00

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    更新日期:2013-01-01 00:00:00

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    pub_type: 杂志文章


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    更新日期:2014-05-01 00:00:00

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    pub_type: 杂志文章


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    更新日期:2014-01-01 00:00:00

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    pub_type: 杂志文章


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    pub_type: 杂志文章


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    更新日期:2020-06-01 00:00:00

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    更新日期:2010-11-01 00:00:00

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    journal_title:Circulation. Cardiovascular quality and outcomes

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Howlett JG,Ezekowitz JA,Podder M,Hernandez AF,Diaz R,Dickstein K,Dunlap ME,Corbalán R,Armstrong PW,Starling RC,O'Connor CM,Califf RM,Fonarow GC,ASCEND-HF Investigators.

    更新日期:2013-09-01 00:00:00