title: Relationship of Provider and Practice Volume to Performance Measure Adherence for Coronary Artery Disease, Heart Failure, and Atrial Fibrillation: Results From the National Cardiovascular Data Registry.
abstract: BACKGROUND
  There is a reported association between high clinical volume and improved outcomes. Whether this relationship is true for outpatients with coronary artery disease (CAD), heart failure (HF), and atrial fibrillation (AF) remains unknown.
  
  
  RESULTS
  Using the PINNACLE Registry (2009-2012), average monthly provider and practice volumes were calculated for CAD, HF, and AF. Adherence with 4 American Heart Association CAD, 2 HF, and 1 AF performance measure were assessed at the most recent encounter for each patient. Hierarchical logistic regression models were used to assess the relationship between provider and practice volume and performance on eligible quality measures. Data incorporated patients from 1094 providers at 71 practices (practice level analyses n=654 535; provider level analyses n=529 938). Median monthly provider volumes were 79 (interquartile range [IQR], 51-117) for CAD, 27 (16-45) for HF, and 37 (24-54) for AF. Median monthly practice volumes were 923 (IQR, 476-1455) for CAD, 311 (145-657) for HF, and 459 (185-720) for AF. Overall, 55% of patients met all CAD measures, 72% met all HF measures, and 58% met the AF measure. There was no definite relationship between practice volume and concordance for CAD, AF, or HF (P=0.56, 0.52, and 0.79, respectively). In contrast, higher provider volume was associated with increased concordance for CAD and AF performance measures (P<0.001 for both), but not for HF (P=0.36).
  
  
  CONCLUSIONS
  In the PINNACLE registry, performance was modest and variable. Higher provider volume was positively associated with quality, whereas practice volume was not.
authors.affiliation: From the Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.); Saint Luke's Mid-America Institute, Kansas City, MO (P.J., P.S.C.); Department of Medicine, University of Missouri, Kansas City (P.C., P.J.); Northwestern University, Department of Surgery, Chicago, IL (A.-C.A.); Veterans Affairs Eastern Colorado Health Care System, University of Colorado, Denver (T.M.M.); and Office of Clinical Practice Innovation, George Washington University, Washington, DC (S.A.F.). Lisa.fleming04@gmail.com.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Fleming
authors.affiliation: From the Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.); Saint Luke's Mid-America Institute, Kansas City, MO (P.J., P.S.C.); Department of Medicine, University of Missouri, Kansas City (P.C., P.J.); Northwestern University, Department of Surgery, Chicago, IL (A.-C.A.); Veterans Affairs Eastern Colorado Health Care System, University of Colorado, Denver (T.M.M.); and Office of Clinical Practice Innovation, George Washington University, Washington, DC (S.A.F.).
authors.forename: Philip
authors.initials: P
authors.lastname: Jones
authors.affiliation: From the Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.); Saint Luke's Mid-America Institute, Kansas City, MO (P.J., P.S.C.); Department of Medicine, University of Missouri, Kansas City (P.C., P.J.); Northwestern University, Department of Surgery, Chicago, IL (A.-C.A.); Veterans Affairs Eastern Colorado Health Care System, University of Colorado, Denver (T.M.M.); and Office of Clinical Practice Innovation, George Washington University, Washington, DC (S.A.F.).
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
authors.affiliation: From the Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.); Saint Luke's Mid-America Institute, Kansas City, MO (P.J., P.S.C.); Department of Medicine, University of Missouri, Kansas City (P.C., P.J.); Northwestern University, Department of Surgery, Chicago, IL (A.-C.A.); Veterans Affairs Eastern Colorado Health Care System, University of Colorado, Denver (T.M.M.); and Office of Clinical Practice Innovation, George Washington University, Washington, DC (S.A.F.).
authors.forename: Adin-Christian
authors.initials: AC
authors.lastname: Andrei
authors.affiliation: From the Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.); Saint Luke's Mid-America Institute, Kansas City, MO (P.J., P.S.C.); Department of Medicine, University of Missouri, Kansas City (P.C., P.J.); Northwestern University, Department of Surgery, Chicago, IL (A.-C.A.); Veterans Affairs Eastern Colorado Health Care System, University of Colorado, Denver (T.M.M.); and Office of Clinical Practice Innovation, George Washington University, Washington, DC (S.A.F.).
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: From the Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.); Saint Luke's Mid-America Institute, Kansas City, MO (P.J., P.S.C.); Department of Medicine, University of Missouri, Kansas City (P.C., P.J.); Northwestern University, Department of Surgery, Chicago, IL (A.-C.A.); Veterans Affairs Eastern Colorado Health Care System, University of Colorado, Denver (T.M.M.); and Office of Clinical Practice Innovation, George Washington University, Washington, DC (S.A.F.).
authors.forename: Steven A
authors.initials: SA
authors.lastname: Farmer
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D002309:Cardiology / Q000592:standards*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D012042:Registries; D014481:United States / Q000453:epidemiology; D016526:Workload
chemical_list: D002317:Cardiovascular Agents
keywords: United States; atrial fibrillation; coronary artery disease; heart failure; outpatients