Effect of Physician Specialty on Treatment Recommendation to Patients with Coronary Artery Disease

Published in: International Journal of Technology Assessment in Health Care, v. 16, no. 1, 2000, p. 190-198

Posted on RAND.org on December 31, 1999

by Joseph McDonnell, Annejet P. Meijler, James P. Kahan, Henk Rigter, Steven J. Bernstein

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OBJECTIVE: To assess the influence of physician specialty and the way in which patient data are presented in the treatment recommended for patients with coronary artery disease. METHODS: In a prospective study, 3,628 patients with significant coronary artery disease who had been referred to 1 of 10 heart centers in the Netherlands as possible candidates for either percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft surgery (CABG) were recruited. Within each center, the recommended treatment is determined by a team consisting of cardiologists only, cardiovascular surgeons only, or cardiologists and cardiovascular surgeons (i.e., composite teams). The main outcome measures are the proportions of patients for whom PTCA, CABG, or noninvasive (medical) therapy was recommended. RESULTS: Composite teams made 71% of recommendations, surgeon-only teams, 12%, and cardiologist-only teams, 17%. Cardiologist-only teams primarily recommended patients to PTCA, surgeon- only teams to CABG, while combined teams made more evenly distributed recommendations (p < .001). Although the patients discussed by the three types of teams were clinically different, the recommendation patterns remained significant after adjusting for these differences (p < .001). For patients with recent myocardial infarction, direct presentation of the case to the team by the referring cardiologist reduced the likelihood that CABG would be recommended. CONCLUSIONS: The treatment recommended to patients with coronary artery disease is affected by the composition of the team providing the recommendation. These findings have important implications for clinical decision making for patients with cardiovascular disease.

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