Abstract
Background: Previous research demonstrates an association between higher surgical volume and improved outcomes; however, there has been limited literature evaluating the association between volume and quality of care in cardiovascular patients. We examined the relationship between volume and compliance with selected outpatient quality measures for coronary artery disease (CAD). Methods: Using a contemporary cohort from the PINNACLE Registry ® (2009-2012), average monthly provider and practice volumes were calculated for CAD encounters. Performance for four American Heart Association (AHA) CAD measures (antiplatelets, beta blockers, ACE inhibitor/ARBs, lipid therapy) was assessed at the most recent encounter for each patient. The percentage of patients meeting 100% of quality measures was calculated for both providers and practices. We fit 3-level hierarchical logistic regression models to assess the relationship between provider and practice volume and performance on quality measures. Results: Data were available for 577,645 patients, representing 1,134 providers from 78 practices nationwide. Monthly practice volumes (median (IQR)) were 683 (251-1466) for CAD encounters and monthly provider volumes were 67 (33-119). Overall, 48% of patients met all CAD measures. The relationship between provider and practice volumes and adherence to performance measures varied significantly. Practice volume was not associated with adherence to performance measures (p = .49), however higher provider volume was positively associated with adherence to performance measures (p < 01) (See Figure 1 ). Conclusions: In the PINNACLE Registry ® performance on published quality measures for CAD was modest and variable. Higher provider volume was positively associated with adherence to performance measures, but there was no association between practice volume and performance.
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