Effects of caregiver specialty on cost and clinical outcomes following hospitalization for heart failure

Harjai, Kishore J.; Boulos, Louis Marie; Smart, Frank W.; Turgut, Tansel; Krousel‐Wood, Marie; Stapleton, Dwight D.; Mehra, Mandeep R.; Murgo, Joseph P.; Ventura, Héctor O.

doi:10.1016/s0002-9149(98)00234-3

Cited by 29 publications

(17 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Increased P-wave dispersion has been noted in hypertensive patients with diastolic dysfunction when compared with patients without diastolic dysfunction 10. Although some studies have suggested that left atrial diameter is an important predictor of atrial fibrillation, and that P-wave duration is related to left atrial dimension, the present study did not observe any relationship between P-wave dispersion and left atrial dimension 11,12…”

Section: Discussioncontrasting

confidence: 80%

P-wave dispersion : relationship to left ventricular function in sickle cell anaemia

Oguanobi

Onwubere²,

Ike³

et al. 2011

CardioVascular Journal of Africa

View full text Add to dashboard Cite

BackgroundThe prognostic implications of P-wave dispersion in patients with a variety of cardiac disease conditions are increasingly being recognised. The relationship between P-wave dispersion and left ventricular function in sickle cell anaemia is unknown.ObjectiveThis study was aimed at evaluating the relationship between P-wave dispersion and left ventricular function in adult Nigerian sickle cell anaemia patients.MethodsBetween February and August 2007, a total of 62 sickle cell anaemia patients (aged 18–44 years; mean 28.27 ± 5.58) enrolled in the study. These were drawn from patients attending the adult sickle cell clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. An equal number of age- and gender-matched normal subjects served as controls. All the participants were evaluated with electrocardiography and echocardiography. P-wave dispersion was defined as the difference between the maximum and minimum P-wave duration measured in a 12-lead electrocardiogram.ResultsP-wave duration and P-wave dispersion were significantly higher in patients than in controls. Significant correlation was demonstrated between P-wave dispersion and age in the patients (r = 0.387; p = 0.031). A comparison of subsets of sickle cell anaemia patients and controls with comparable haematocrit values (30–35%) showed significantly higher P-wave duration and P-wave dispersion in the patients than in the controls. The P-wave duration in patients and controls, respectively, was 111.10 ± 14.53 ms and 89.14 ± 16.45 ms (t = 3.141; p = 0.006). P-wave dispersion was 64.44 ± 15.86 ms in the patients and 36.43 ± 10.35 ms in the controls (t = 2.752; p = 0.013). Significant negative correlation was found between P-wave dispersion and left ventricular transmitral E/A ratio (r = –0.289; p = 0.023).ConclusionThese findings suggest that P-wave dispersion could be useful in the evaluation of sickle cell patients with left ventricular diastolic dysfunction. Further prospective studies are recommended to evaluate its prognostic implication on the long-term disease outcome in sickle cell disease patients.

show abstract

Section: Discussioncontrasting

confidence: 80%

P-wave dispersion : relationship to left ventricular function in sickle cell anaemia

Oguanobi

Onwubere²,

Ike³

et al. 2011

CardioVascular Journal of Africa

View full text Add to dashboard Cite

show abstract

“…Such a discrepancy may be partly explained by differences between studies in patient selection, targeted processes of care, or duration of follow-up. Moreover, cohort studies 7,23,24 that compared care between medical specialties in teaching hospitals might not detect the heterogeneity that would otherwise be observed in community practice. Presumably, generalists attending in teaching hospitals would adhere more closely to evidence-based care than generalists in the community, therefore lessening the chance of finding a difference that would be attributed to variation between physician groups.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is known that proportionally more patients of cardiologists have systolic dysfunction compared with generalists. 7,23,29 Because survival is better with diastolic than systolic dysfunction, 35 adjusting for ejection fraction may only magnify and not diminish the already disparate mortality observed between the physician groups. As in the case for all observational studies, a potential exists for unmeasured confounders that may bias our results.…”

Section: Discussionmentioning

confidence: 99%

Care and Outcomes of Patients Newly Hospitalized for Heart Failure in the Community Treated by Cardiologists Compared With Other Specialists

et al. 2003

View full text Add to dashboard Cite

Background-It is not known whether subspecialty care by cardiologists improves outcomes in heart failure patients from the community over care by other physicians. Methods and Results-Using administrative data, we monitored 38 702 consecutive patients with first-time hospitalization for heart failure in Ontario, Canada, between April 1994 and March 1996 and examined differences in processes of care and clinical outcomes between patients attended by physicians of different disciplines. We found that patients attended by cardiologists had lower 1-year risk-adjusted mortality than those attended by general internists, family practitioners, and other physicians (28.5% versus 31.7%, 34.9%, and 35.9%, respectively; all pairwise comparisons, PϽ0.001). The 1-year risk-adjusted composite outcome of death and readmission for heart failure was also lower for the cardiologists compared with family practitioners and other physicians but not general internists (54.7% versus 58.1%, 58.3%, and 55.4%; PϽ0.001, PϽ0.001, and Pϭ0.39, respectively). Multivariable hierarchical modeling demonstrated a significant physician-level effect for both outcomes in favor of the cardiologists, particularly against non-general internists.Cardiologist care was associated with higher adjusted rates of invasive interventions and postdischarge prescriptions of heart failure medications. Conclusions-In this population-based cohort, heart failure patients attended by cardiologists in hospital had lower risk of death as well as the composite risk of death or readmission than patients attended by noncardiologists. These data raise the need to identify specialty-driven differences in processes of care for heart failure patients, which may explain the observed disparity in clinical outcomes that presently favor cardiologist care.

show abstract

“…Chief among these is provider specialty. Hospitals able to provide advanced cardiac facilities are likely to attract a greater number of specialists, who in turn might provide care of greater quality [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Reimbursement and Quality of Care for Patients Hospitalized with Heart Failure

Havranek¹,

Wolfe²,

Foody³

et al. 2008

TOHSPJ

View full text Add to dashboard Cite

Data supporting the existence of a relationship between reimbursement and quality are limited. We assessed the association between quality of care for 34,318 patients hospitalized with heart failure across the US and heart failure Diagnosis-Related Group (DRG) payment for the 3,905 hospitals at which patients were admitted. Payment varied from $2606 to $11,845. We found a discontinuous relationship between documentation of ejection fraction and payment; below $4200, there was a steep increase in rates of the quality indicator with increasing DRG payment (OR 1.15 for each $100 increase, 95% CI 1.12-1.18). For ACE inhibitor prescription, the increase in rates below the threshold was of borderline significance (OR 1.04 for each $100 increase, 95% CI 1.00-1.07). Hospitals with reimbursement below the threshold were more likely non-urban (p<0.001), public (p<0.0001), and without advanced cardiac facilities (p<0.0001), and had fewer full-time registered nurses per adjusted patient-day (p<0.0001). We conclude that hospitals with low rates of Medicare DRG-based reimbursement have lesser performance on a heart failure quality measure, perhaps because of difficulty investing in advanced cardiac facilities or maintaining patient care staffing.

show abstract

Effects of caregiver specialty on cost and clinical outcomes following hospitalization for heart failure

Cited by 29 publications

References 13 publications

P-wave dispersion : relationship to left ventricular function in sickle cell anaemia

P-wave dispersion : relationship to left ventricular function in sickle cell anaemia

Care and Outcomes of Patients Newly Hospitalized for Heart Failure in the Community Treated by Cardiologists Compared With Other Specialists

The Relationship Between Reimbursement and Quality of Care for Patients Hospitalized with Heart Failure

Contact Info

Product

Resources

About