CPO Team Assesses Effectiveness of Physician Board Certification in New Peer-Reviewed Study

Does a physician need to be board-certified in order to deliver top-quality clinical care to patients? A team of researchers from the CPO and other institutions sought to answer this question, by using statistical analysis to compare the work of board-certified and non-board-certified anesthesiologists. Examining the National Anesthesia Clinical Outcomes Registry database, the team studied the treatment and outcomes of Total Knee Arthroplasty (TKA), a procedure known commonly as knee replacement. The team discovered that board-certified anesthesiologists utilized neuraxial, or regional, anesthesia, as opposed to general anesthesia, at a rate greater than that of non-board-certified anesthesiologists.

The research team included, from the CPO: Peter M. Fleischut, MD, Jonathan M. Eskreis-Winkler, Licina K. Gaber-Baylis, Gregory P. Giambrone, Xian Wu, Xuming Sun, Cynthia Lien, MD, Susan Faggiani, RN, as well as Richard P. Dutton, MD, of the University of Chicago, and Stavos G. Memtsoudis, MD, PhD, of the Hospital for Special Surgery. Their article, “Provider Board Certification Status and Practice Patterns in Total Knee Arthroplasty” was published ahead-of-print by the journal, Academic Medicine, on July 21, 2015, and will appear in a forthcoming issue of the journal.

Academic Medicine released the following abstract:

 Purpose: The presumption that board certification directly affects the quality of clinical care is a topic of ongoing discussion in medical literature. Recent studies have demonstrated disparities in patient outcomes associated with type of anesthesia provided for total knee arthroplasty (TKA); improved outcomes are associated with neuraxial (or regional) versus general anesthesia. Whether board-certified (BC) and non-board-certified (nBC) anesthesiologists make different choices in the anesthetic they administer is unknown. The authors sought to study potential associations of board certification status with anesthesia practice patterns for TKA.

Method: The authors accessed records of anesthetics provided from 2010 to 2013 from the National Anesthesia Clinical Outcomes Registry database. They identified TKA cases using Clinical Classifications Software and Current Procedural Terminology codes. The authors divided practitioners into two groups: those who were BC and those who were nBC. For each of these groups, the authors compared the following: their patient populations, the hospitals in which they worked, the nature of their practices, and the anesthetics they administered to their patients.

Results: BC anesthesiologists provided care for 81.7% of 97,508 patients having TKA; 18.3% were treated by nBC anesthesiologists. BC anesthesiologists administered neuraxial/regional anesthesia more frequently than nBC anesthesiologists (41.4% versus 21.2%; P < .001).

Conclusions: The rates at which regional/neuraxial anesthesia were administered for TKA were relatively low, and there were significant differences in practice patterns of BC and nBC anesthesiologists providing care for patients undergoing TKA. More research is necessary to understand the causes of these disparities.

The full abstract and article can be accessed via Academic Medicine HERE.


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