Determining Value of a Cardiology Clinic Visit
Tripti Gupta 1,2 , Stephanie Madonis 1 , Ivana Okor 3 , Koyenum Obi 3 , Gregory A Desrosiers 4 , Alaa Mohammed 5 , Daniel Fort 5 , Mark B. Effron 1,2
1 Department of Cardiology, Ochsner Medical Center, New Orleans, LA 2 University of Queensland Ochsner Clinical School of Medicine, New Orleans, LA 3 Department of Internal Medicine, Ochsner Medical Center, New Orleans, LA 4 Department of Internal Medicine, University of Tennessee, Knoxville, TN 5 Ochsner Health Center for Outcomes and Health Services Research, New Orleans, LA Background Value based healthcare is gaining momentum to minimize extraneous medical costs and improve patient outcomes. The frequency of specialty clinic visits may be contributing to excessive cost and resource utilization without affecting patient outcomes. Follow up frequency is largely controlled by physicians with few metrics to guide scheduling. Patients with stable cardiac conditions and controlled risk factors may be able to be followed less frequently without affecting overall outcomes. Objective This study is designed to evaluate the relation between frequency of Cardiology Clinic (Card Cl) visits and major adverse cardiac events (MACE) post percutaneous coronary intervention in patients with acute coronary syndrome (ACS). Methods A retrospective cohort study was conducted of all patients diagnosed with acute coronary syndrome receiving a stent during index hospitalization between Jan 1 2012 – Dec 312014 at Ochsner Medical Center (OMC). Patients who did not have an OMC Card Cl visit in the 5 years following stenting up were excluded. Primary analysis included bivariate analysis (chi-square and t-test as appropriate) and multivariate logistic regression (MVLR) to determine odds of MACE. MACE was defined as a composite of hospitalization for congestive heart failure, non-fatal myocardial infarction, ACS, cerebrovascular accident, or all-cause mortality. Results 533 patients were identified of which 68.3% were male. Of 17 variables evaluated, the presence of end stage renal disease and older age were predictive of increased frequency (> 10) of clinic visits, [OR 1.58, (95% CI 1.11 – 2.24), p = 0.011 and 1.03, (95% CI 1.02 – 1.05), p = < 0.01)], respectively. A higher frequency of clinic visits (> 10 vs < 10) was correlated with MACE (OR 2.72, (95% CI 1.88 – 4.00), p < 0.001). In a MVLR model, presence of diabetes, congestive heart failure and > 10 clinic visits were correlated with MACE (Table). Conclusion Underlying pathology appears to be more influential on frequency of Card Cl visits and MACE such that patients with more comorbidities tend to have more frequent clinic visits and worse CV outcomes.
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