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Physician and Patient Influences on Provider Performance: {beta}-Blockers in Post-Myocardial Infarction Management in the MI-Plus Study
Quantitative Health Sciences Publications and Presentations
  • Ellen M. Funkhouser, University of Alabama
  • Thomas K. Houston, University of Massachusetts Medical School
  • Deborah A. Levine, Ohio State University
  • Joshua S. Richman, University of Alabama at Birmingham
  • Jeroan J. Allison, University of Massachusetts Medical School
  • Catarina I. Kiefe, University of Massachusetts Medical School
UMMS Affiliation
Department of Quantitative Health Sciences
Publication Date
Document Type
Physician's Practice Patterns; Adrenergic beta-Antagonists; Myocardial Infarction
Background efforts to improve the quality of care for patients with cardiovascular disease frequently target the decrease of physician-level performance variability. We assessed how variability in providing beta-blockers to ambulatory postmyocardial infarction (MI) patients was influenced by physician and patient level characteristics. Methods and Results beta-Blocker prescription and patient characteristics were abstracted from charts of post-MI patients treated by 133 primary care physicians between 2003 and 2007 and linked to physician and practice characteristics. Associations of beta-blocker prescription with physician- and patient-level characteristics were examined using mixed-effects models, with physician-level effects as random. Mean physician-specific predicted probabilities and the intraclass correlations, which assessed the proportion of variance explainable at the physician level, were estimated. Of 1901 patients without major contraindication, 69.1% (range across physicians, 20% to 100%) were prescribed beta-blockers. Prescription varied with comorbidity from 78.3% in patients with chronic kidney disease to 54.7% for patients with stroke. Although physician characteristics such as older physician age, group practice, and rural location were each positively associated with beta-blocker prescription, physician factors accounted for only 5% to 8% of the variance in beta-blocker prescription; the preponderance of the variance, 92% to 95%, was at the patient level. The mean physician-specific probability of beta-blocker prescription (95% confidence interval) in the fully adjusted model was 63% (61% to 65%). Conclusions beta-Blocker prescription rates were surprisingly low. The contribution of physician factors to overall variability in beta-blocker prescription, however, was limited. Increasing evidence-based use of beta-blockers may not be accomplished by focusing mostly on differential performance across physicians.
  • UMCCTS funding
DOI of Published Version
Circ Cardiovasc Qual Outcomes. 2011 Jan 1;4(1):99-106. Epub 2010 Dec 7. doi:10.1161/CIRCOUTCOMES.110.942318. Link to article on publisher's site
PubMed ID
Related Resources
Link to Article in PubMed
Citation Information
Ellen M. Funkhouser, Thomas K. Houston, Deborah A. Levine, Joshua S. Richman, et al.. "Physician and Patient Influences on Provider Performance: {beta}-Blockers in Post-Myocardial Infarction Management in the MI-Plus Study" Vol. 4 Iss. 1 (2011) ISSN: 1941-7713 (Linking)
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