Concurrent improvements in ambulatory cardiac catheterization practices following inpatient interventions.
Questions have been increasingly raised about the value of performing right heart catheterization. A preliminary analysis done in 1992 revealed significant interhospital variation in the frequency of the procedure among Medicare Part A and Medicaid patients in New York State, and it also suggested that the procedure was being performed routinely in some hospitals. In 1993, IPRO initiated a cooperative health care quality improvement program involving the state's 53 catheterization laboratories. As a result of this educational intervention, the rate of bilateral catheterization among Medicare Part A patients fell from 89/100,000 beneficiaries in 1992 to 65/100,000 in 1996, and the overall percentage of catheterized Medicare patients undergoing bilateral catheterization fell from 30.5% in 1992 to 17.4%. A major question was whether a corresponding decrease had occurred among ambulatory patients (Medicare Part B). To determine the answer, the Medicare Part B database was analyzed for the identical period of time. It was found that the percentage of ambulatory Medicare patients who underwent bilateral catheterization at the 53 laboratories fell from 37.6% in 1992 to 17.0% in 1996, paralleling the decline observed among inpatients. The results of this quality improvement study show that an educational intervention directed at inpatient practice patterns can have a similar impact on outpatient patterns.
Imperato
P J
PJ
IPRO, Lake Success, NY, USA.
Malach
M
M
Nenner
R P
RP
Starr
H
H
Huang
T
T
Dearie
M
M
D000556:Ambulatory Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D006328:Cardiac Catheterization / Q000191:economics / Q000706:statistics & numerical data*; D004502:Education, Medical, Continuing; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data; D016344:Medicare Part A / Q000706:statistics & numerical data; D016345:Medicare Part B / Q000706:statistics & numerical data; D009518:New York / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D017749:Total Quality Management; D014481:United States; D014600:Utilization Review