Author + information
- Received October 11, 2010
- Revision received April 4, 2011
- Accepted April 11, 2011
- Published online June 1, 2011.
- Jersey Chen, MD, MPH⁎,⁎ (, )
- Reza Fazel, MD, MSc¶,
- Joseph S. Ross, MD, MHS†,
- Robert L. McNamara, MD, MHS⁎,
- Andrew J. Einstein, MD, PhD#,⁎⁎,
- Mouaz Al-Mallah, MD††∥∥,
- Harlan M. Krumholz, MD, SM⁎,‡,§∥ and
- Brahmajee K. Nallamothu, MD, MPH‡‡,§§
- ↵⁎Reprint requests and correspondence:
Dr. Jersey Chen, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520
Objectives The goal of this study was to compare patterns of downstream testing and procedures after stress testing with imaging performed at physician offices versus at hospital-outpatient facilities
Background Stress testing with imaging has grown dramatically in recent years, but whether the location of where the test is performed correlates with different patterns for subsequent cardiac testing and procedures is unknown
Methods We identified 82,178 adults with private health insurance from 2005 to 2007 who underwent ambulatory myocardial perfusion imaging (MPI) or stress echocardiography (SE). Subsequent MPI, SE, cardiac catheterization or revascularization within 6 months was compared between physician office and hospital outpatient settings.
Results Overall, 85.1% of MPI and 84.9% of SE were performed in physician offices. The proportion of patients who underwent subsequent MPI, SE, or cardiac catheterization was not statistically different between physician office and hospital outpatient settings for MPI (14.2% vs. 13.9%, p = 0.44) or SE (7.9% vs. 8.6%, p = 0.21). However, patients with physician office imaging had slightly higher rates of repeat MPI within 6 months compared with hospital-outpatient imaging for both index MPI (3.5% vs. 2.0%, p < 0.001) and SE (3.4% vs. 2.1%, p < 0.001), and slightly lower rates of cardiac catheterization after index MPI (11.4% vs. 12.2%, p = 0.04) and SE (4.5% vs. 7.0%, p < 0.001). Differences in 6-month utilization were observed across the 5 healthcare markets after index MPI but not after index SE
Conclusions Physician office imaging is associated with slightly higher repeat MPI and fewer cardiac catheterizations than hospital outpatient imaging, but no overall difference in the proportion of patients undergoing additional further testing or procedures. Although regional variation exists, especially for MPI, the relationship between physician office location of stress testing with imaging and greater downstream resource utilization appears modest.
- health policy
- health services research
- myocardial perfusion imaging
- physician office imaging
- stress echocardiography
Dr. Chen is supported by an American Heart Association Clinical Research Program Award (AHA 10CRP2640075) and an Agency for Healthcare Research and Quality Career Development Award (1K08HS018781-01). Dr. Ross is supported by the National Institute on Aging (K08 AG032886) and by the American Federation of Aging Research through the Paul B. Beeson Career Development Award Program. Dr. Einstein was supported in part by a National Institutes of Health K12 institutional career development award (KL2 RR024157), and by the Louis V. Gerstner, Jr. Scholars Program. Dr. Krumholz is supported by a National Heart Lung Blood Institute Cardiovascular Outcomes Center Award (1U01HL105270-01). Dr. Einstein reports having received research support from Spectrum Dynamics. Dr. Krumholz has received consulting fees for serving on the United Healthcare Cardiac Scientific Advisory Board. He received no fees related to this project. All other authors have reported they have no relationships to disclose.
- Received October 11, 2010.
- Revision received April 4, 2011.
- Accepted April 11, 2011.
- American College of Cardiology Foundation