Practitioner Gender and Quality of Care in Ambulatory Cardiology Practices: A Report From the National Cardiovascular Data Practice Innovation and Clinical Excellence (PINNACLE) Registry.
Practitioner Gender and Quality of Care in Ambulatory Cardiology Practices: A Report From the National Cardiovascular Data Practice Innovation and Clinical Excellence (PINNACLE) Registry.
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门诊心脏病学实践中的从业者性别和护理质量：来自国家心血管数据实践创新和临床卓越 (PINNACLE) 注册中心的报告。
DOI：
10.1097/jcn.0000000000000443
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Daugherty,StacieL
中科院分区：
文献类型：
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作者：
Gupta,Dipti;Tang,Fengming;Masoudi,FrederickA;Jones,PhilipG;Chan,PaulS;Daugherty,StacieL
背景：一些研究表明，女性医生比男性医生更有可能提供符合指南的护理；然而，对医生性别在心脏病学中的作用知之甚少。目的：本研究的目的是测量医生性别与依从美国心脏病学会门诊实践创新和临床卓越注册中心心血管性能指标之间的关系。方法：患者至少有一次门诊访问与一个独特的医生包括。在符合条件的患者中，在登记后的12个月内，对7项指南支持的冠状动脉疾病、心力衰竭和心房颤动的表现指标的依从性进行比较，使用调整从业者类型（医生vs高级执业从业者）和就诊次数的从业者性别分层模型。结果：研究队列包括1493名个体执业医师，共见769 139例患者；80%的从业者是男性。男性执业医师比女性执业医师更多(98.2% vs 43.7%， P<。01)。考虑到从业人员类别和就诊频率，除男性从业人员冠状动脉疾病表现测量率略高于女性从业人员外，所有测量指标的指南依从率相似(抗血小板：比率比[RR]= 1.06； 95%可信区间[CI]， 1.03-1.09； β受体阻滞剂：RR= 1.06; 95% CI, 1.01-1.10；降脂药物：RR= 1.07；95% CI, 1.04-1.10)和房颤（口服抗凝剂：RR= 1.05; 95% CI, 1.01-1.09）。结论：在自愿心血管表现改善登记项目的门诊实践中，男性从业者的表现略微优于女性同行。对某些绩效指标的总体依从性较低，表明所有从业人员都有改进的余地。
Background:Some studies suggest that female practitioners are more likely to provide guideline-concordant care than male practitioners; however, little is known about the role of practitioner gender in cardiology.Objective:The aim of the study was to measure the association between practitioner gender and adherence to the cardiovascular performance measures in the American College of Cardiology's ambulatory Practice Innovation and Clinical Excellence Registry.Methods:Patients with at least 1 outpatient visit with a unique practitioner were included. Among eligible patients, adherence to 7 guideline-supported performance measures for coronary artery disease, heart failure, and atrial fibrillation over 12 months after registry entry was compared by practitioner gender using hierarchical models adjusting for practitioner type (physicians vs advance practice practitioners) and number of visits.Results:The study cohort included 1493 individual practitioners who saw 769 139 patients; 80% of practitioners were men. Male practitioners were more often physicians compared with female practitioners (98.2% vs 43.7%, P<. 01). Accounting for practitioner category and visit frequency, guideline adherence rates were similar by practitioner gender for all measures with the exception of marginally higher rates for coronary artery disease performance measures for male practitioners compared with female practitioners (antiplatelet: rate ratio [RR]= 1.06; 95% confidence interval [CI], 1.03–1.09; β-blockers: RR= 1.06; 95% CI, 1.01–1.10; and lipid-lowering drug: RR= 1.07; 95% CI, 1.04–1.10) and atrial fibrillation (oral anticoagulants: RR= 1.05; 95% CI, 1.01–1.09).Conclusion:Male practitioners marginally outperformed their female counterparts in ambulatory practices enrolled in a voluntary cardiovascular performance improvement registry program. Overall low adherence to some performance measures suggests room for improvement among all practitioners.