{"id":10839,"date":"2011-08-18T10:05:37","date_gmt":"2011-08-18T14:05:37","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=interventional&p=10839"},"modified":"2011-08-18T10:24:57","modified_gmt":"2011-08-18T14:24:57","slug":"are-interventionalists-getting-too-far-a-head","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/08\/18\/are-interventionalists-getting-too-far-a-head\/","title":{"rendered":"Are Interventionalists Getting Too Far “A Head”?"},"content":{"rendered":"

Nallamothu\u00a0and\u00a0colleagues have\u00a0performed an observational analysis<\/em><\/strong> <\/a>of Medicare data on fee-for-service beneficiaries undergoing carotid stenting between 2005 and 2007 in 306 hospital referral regions (HRRs).\u00a0First, they\u00a0determined how often carotid stenting was performed by different specialists<\/em><\/strong> (i.e., cardiologists, surgeons, radiologists) within each HRR, then they\u00a0compared utilization rates and 30-day outcomes<\/em><\/strong>\u00a0of the procedure across HRRs.<\/p>\n

What did they find?<\/em><\/strong><\/p>\n

    \n
  1. Although only about one-third of the operators were cardiologists, they performed over half (52%) of the procedures; surgeons\u00a0performed 28%, and radiologists\u00a0performed 18% (see the graph in the report<\/a> published in Archives of Internal Medicine<\/em>).<\/li>\n
  2. Utilization rates for carotid stenting were significantly higher in HRRs where cardiologists performed most of the procedures\u00a0than in\u00a0HRRs where most\u00a0of the procedures were\u00a0performed by other specialists (P<\/em><0.001).<\/li>\n
  3. Risk-standardized outcomes did not differ across HRRs based on physician specialty.<\/li>\n<\/ol>\n

    Conclusion<\/strong>: Hospital referral regions where cardiologists perform most procedures have higher population-based utilization rates with similar outcomes.<\/em><\/strong><\/p>\n

    Are markets where cardiologists<\/em><\/strong> are performing most procedures overutilizing<\/em><\/strong> carotid stenting, or are markets where surgeons or radiologists<\/em><\/strong> perform most of them underutilizing <\/em><\/strong>it (i.e., does\u00a0involvement of cardiologists in the care of these patients lead to a greater recognition of carotid disease in the general population and subsequent referral for carotid stenting)?
    \n
    \nWhich is it?<\/em><\/strong><\/p>\n

    A \u201cHeart Team\u201d approach is advocated for decisions regarding surgical versus percutaneous treatment of multivessel CAD and aortic stenosis.\u00a0Should we adopt such an approach to promote multidisciplinary decision making\u00a0about carotid stenting (i.e., the “Head Team Approach”)?<\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

    Nallamothu\u00a0and\u00a0colleagues have\u00a0performed an observational analysis of Medicare data on fee-for-service beneficiaries undergoing carotid stenting between 2005 and 2007 in 306 hospital referral regions (HRRs).\u00a0First, they\u00a0determined how often carotid stenting was performed by different specialists (i.e., cardiologists, surgeons, radiologists) within each HRR, then they\u00a0compared utilization rates and 30-day outcomes\u00a0of the procedure across HRRs. What did they […]<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,9],"tags":[390],"class_list":["post-10839","post","type-post","status-publish","format-standard","hentry","category-general","category-interventional-cardiology","tag-carotid-stenting"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/10839","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=10839"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/10839\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=10839"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=10839"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=10839"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}