The American Heart Hospital Journal
Table 1: Baseline Characteristics of Patients by Physician Group CHARACTERISTIC
INTERNIST WP*
n Age Female gender
ETHNICITY White Black
Hispanic Other
INSURANCE Medicare Medicaid
Commercial Other
1,819
56.3 21.8 17.2 4.6
58.4 6.5
31.0 4.1
CARDIOVASCULAR DIAGNOSIS CATEGORY APRDRG† Without procedure 190 198 201 203
12.1 28.0 18.0 41.8
APRDRG‡ With procedure 165 171 173 174 175 191 192
SEVERITY 1 2 3 4
43.4 42.9 11.6 2.1
19.9 5.7 5.8 6.8 9.3
12.5 40.1
31.5 40.0 23.7 4.9
44.7 40.2 12.1 3.0
deviation or percentage of column within each category or characteristic. †
‡ P*
64.5 ± 15.7 63.4 ± 13.4 59.7 ± 15.9 61.8 ± 13.4 63.5 ± 14.5 64.8 ± 12.8 61.4 ± 5.8 63.4 ± 13.2 60.7
1,339 45.2 65.2
17.6 13.1 4.1
53.9 5.2
36.7 4.1
4,290 57.1 58.3
24.6 14.7 2.4
44.9 5.5
43.6 6.0
11.2 25.8 17.0 46.0
26.1 6.0 7.6 4.4 6.7
12.0 37.2
26.5 37.2 29.1 7.2
48.0 38.6 11.2 2.2
3,283 44.5 65.7
18.5 13.1 2.7
50.2 5.1
39.3 5.5
42.3 79.8
8.2 8.2 3.8
51.8 2.3
42.1 3.8
21.2 14.4 56.0 8.3
21.1 13.3 6.0 6.3
25.5 8.8
19.0 41.7
38.0 15.9 4.3
44.7 40.8 11.9 2.7
3,613 37.4 81.4
7.0 8.2 3.4
57.2 3.2
36.0 3.6
6,878 56.4 60.2
22.0 14.7 3.1
49.2 5.4
40.1 5.2
12.6 25.1 21.6 40.7
22.9 9.2 6.6 5.6
15.4 10.7 29.7
34.0 38.0 22.5 5.6
*WP represents a cardiovascular APRDRG without procedure and P represents a cardiovascular APRDRG with procedure. Numbers are mean ± standard 190 is acute myocardial infarction (MI). 198 is angina pectoris. 201 is cardiac arrhythmia. 203 is chest pain.
165 is coronary bypass with cardiac catheterization. 171 is cardiac pacemaker implant. 173 is other vascular procedures. 174 is percutaneous procedures with MI. 175 is percutaneous procedures without MI. 191 is cardiac catheterization without ischemia. 192 is cardiac catheterization for heart ischemia. APRDRG = All Patient Refined Diagnosis Related Group.
8,235 41.5 72.5
13.3 11.0 3.2
53.9 4.3
37.4 4.4
Original Contribution
HOSPITALIST WP*
PHYSICIAN GROUP P*
CARDIOLOGIST WP* 769
P*
TOTAL WP*
P*
Study Patients. All cardiovascular APRDRGs with more than 200 cases total and at least 50 cases per physician group during the study period were included. These high-frequency APRDRGs were selected in order to assure that statistical adjustment for confounding demographic factors, severity, and ROM could be carried out. There were 15,103 patients who met these criteria. The APRDRGs were subdivided into two groups that included a cardiovascular procedure performed by a cardiologist (Procedure group) or did not include a procedure (Without Procedure group).
All patients were admitted to the same hospital units and the intensive care and cardiac care units were of ‘open’ design. The attending physicians performed their own
Winter 2011
rounds and sought consultation as needed. The study was approved by the organization’s Institutional Review Board prior to the investigation.
Design and Statistical Analysis. The design was a retrospective cohort study. The hypothesis tested was that there was no difference among hospitalists, general internists, and cardiologists for hospital cost, LOS, hospital mortality, or 30-day readmissions, regardless of the principal attending physician. Endpoints (hospital cost, LOS, hospital mortality, and 30-day readmission) were calculated per hospital admission. Physician fees were not included in costs. Costs were controlled for inflation by introduction of an adjustment factor for year of study in the multivariate analysis, thus assuring that costs were
Finding a Cardiologist’s Most Efficient and Effective Role 83
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