The association between provider characteristics and post-catheterization interventions.

Objectives: To examine whether the demographics of providers' prior year patient cohorts, providers' historic degree of catheter-based fractional flow reserve (FFR) utilization, and other provider characteristics were associated with post-catheterization performance of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).

Study Design: A retrospective, observational analysis of outpatient claims data was performed.

Methods: All 2018 outpatient catheterization claims from a national organization offering commercial and Medicare Advantage health plans were examined. Claims were excluded if the patient had a prior catheterization in 2018, had any indications of CABG or valvular heart disease in the prior year of claims, or if the provider had ≤10 catheterization claims in 2017. Downstream PCI and CABG were determined by examining claims 0-30 days post-catheterization. Using multivariate mixed effects logistic regression with provider identity random effects, the association between post-catheterization procedures and provider characteristics was assessed, controlling for patient characteristics.

Results: The sample consisted of 31,920 catheterization claims pertaining to procedures performed by 964 providers. Among the catheterization claims, 8,554 (26.8%) were followed by PCI and 1,779 (5.6%) were followed by CABG. Catheterizations performed by providers with older prior year patient cohorts were associated with higher adjusted odds of PCI (1.78; CI: 1.26-2.53), even after controlling for patient age. Catheterizations performed by providers with greater historic use of FFR had significantly higher adjusted odds of being followed by PCI (1.73; CI: 1.26-2.37).

Conclusion: Provider characteristics may impact whether patients receive a procedure post-catheterization. Further research is needed to characterize this relationship.