Daniel M Blumenthal

Partners HealthCare · Department of internal medicine

Background Little is known about patterns of PCSK9i (proprotein convertase subtilisin/kexin type 9 inhibitor) use among patients with established clinical atherosclerotic cardiovascular disease. This study’s objective was to describe PCSK9i prescribing patterns among patients with atherosclerotic cardiovascular disease. Methods We used a national...

Background A study has shown that industry payments to physicians for drugs are associated not only with higher drug prescriptions but also with higher non-drug costs due to additional utilization of healthcare services. However, the association between industry payments to cardiologists for antiplatelet drugs and the costs and number of percutaneo...

Importance Angina pectoris is associated with morbidity and mortality. Angina prevalence and frequency among contemporary US populations with coronary artery disease (CAD) remain incompletely defined. Objective To ascertain the angina prevalence and frequency among stable outpatients with CAD. Design, Setting, and Participants This cross-sectiona...

Objective To determine the potential association between physician gender and academic advancement among US rheumatologists. Methods We performed a nationwide, cross‐sectional study of all rheumatologists practicing in the US in 2014 using a comprehensive database of all licensed physicians. Among academic rheumatologists, we estimated gender diff...

Background: This study assesses differences in faculty rank between female and male infectious diseases (ID) faculty with academic appointments at US medical schools. Methods: We analyzed a complete database of US physicians with medical school faculty appointments in 2014. This database consists of a linkage between the American Association of...

Objective: The aim of this study was to compare patient outcomes between International Medical Graduate (IMG) versus US medical graduate (USMG) surgeons. Summary background data: One in 7 surgeons practicing in the US graduated from a foreign medical school. However, it remains unknown whether patient outcomes differ between IMG versus USMG surg...

Objective To investigate the association between physician characteristics and the value of industry payments. Design Observational study. Setting and participants Using the 2015–2017 Open Payments reports of industry payments linked to the Physician Compare database, we examined the association between physician characteristics (physician sex, y...

Objective To determine whether 30 day mortality, 30 day readmissions, and inpatient spending vary according to whether physicians were exposed to work hour reforms during their residency. Design Retrospective observational study. Setting US Medicare. Participants 20% random sample (n=485 685) of Medicare beneficiaries aged 65 years or more admit...

Background: Female physicians are significantly less likely than male physicians to be full professors, even after accounting for age, experience, specialty, and measures of research and clinical productivity. Objective: We sought to evaluate sex differences in academic rank in the allergy and immunology workforce. Methods: We used a cross-sec...

Importance One-third of Medicare beneficiaries are enrolled in Medicare Advantage (MA), Medicare’s private plan option. Medicare Advantage incentivizes performance on evidence-based care, but limited information exists using reliable clinical data to determine whether this translates into better quality for patients with coronary artery disease (CA...

Background The purpose of this study was to complete a comprehensive analysis of gender differences in faculty rank among United States (U.S.) emergency physicians that reflected all academic emergency physicians. Methods We assembled a comprehensive list of academic emergency medicine physicians with U.S. medical school faculty appointments from...

Importance Each year, billions of dollars are wasted owing to health care fraud, waste, and abuse. Efforts to detect fraud have been increasing, yet we have little information about physicians who have been excluded from Medicare and state public insurance programs for fraud, health crimes, or the unlawful prescribing of controlled substances. Obj...

Objectives To examine patterns of golfing among physicians: the proportion who regularly play golf, differences in golf practices across specialties, the specialties with the best golfers, and differences in golf practices between male and female physicians. Design Observational study. Setting Comprehensive database of US physicians linked to the...

Background Sex differences in faculty achievement in academic medicine have been described, but little is known about these differences in infectious diseases (ID). This study assesses differences in faculty rank between female and male infectious disease faculty with academic appointments at US medical schools. Methods We analyzed a complete data...

In 2016, the Center for Medicare and Medicaid Innovation (CMMI) launched the Comprehensive Care for Joint Replacement (CJR) program, a pilot evaluation of 90-day episode payments for lower-extremity joint replacements (LEJR).¹ Under the CJR model, a 5-year program, participating hospitals receive bundled payments for knee and hip replacements that...

Objective To investigate whether the US News & World Report (USNWR) ranking of the medical school a physician attended is associated with patient outcomes and healthcare spending. Design Observational study. Setting Medicare, 2011-15. Participants 20% random sample of Medicare fee-for-service beneficiaries aged 65 years or older (n=996 212), who...

Supplementary information: eTables 1-14

Importance Medicare’s Bundled Payments for Care Improvement (BPCI) is a voluntary pilot program evaluating bundled payments for several common cardiovascular conditions. Evaluating the external validity of this program is important for understanding the effects of bundled payments on cardiovascular care. Objective To determine whether participants...

Importance Public reporting of procedural outcomes has been associated with lower rates of percutaneous coronary intervention (PCI) and worse outcomes after myocardial infarction. Contemporary data are limited on the influence of public reporting on interventional cardiologists’ clinical decision making. Objective To survey a contemporary cohort o...

Objective To investigate whether patients’ mortality differs according to the age and sex of surgeons. Design Observational study. Setting US acute care hospitals. Participants 100% of Medicare fee-for-service beneficiaries aged 65-99 years who underwent one of 20 major non-elective surgeries between 2011 and 2014. Main outcome measure Operativ...

Supplementary tables and figures

Table S1. Thirty‐Day PCI Rates Among Patients Admitted With AMI During TCT Meeting and Non‐Meeting Dates Table S2. Characteristics of Patients Hospitalized With NSTEMI During Meeting and Non‐Meeting Dates, According to Whether PCI was Performed During Hospitalization Table S3. Falsification Analyses Table S4. Hospital Transfers During Meeting an...

Background Previous research has found that patients with acute cardiovascular conditions treated in teaching hospitals have lower 30‐day mortality during dates of national cardiology meetings. Methods and ResultsWe analyzed 30‐day mortality among Medicare beneficiaries hospitalized with acute myocardial infarction (overall, ST‐segment–elevation my...

Background: The management of patients presenting to an emergency department with chest discomfort at low-risk for acute coronary syndrome represents a common clinical challenge. Such patients are often triaged to chest pain units for monitoring and cardiac stress testing for further risk stratification. Methods: We conducted a retrospective stu...

Objective: The aim of this study was to evaluate sex differences in full professorship among a comprehensive, contemporary cohort of US academic surgeons. Summary of background data: Previous work demonstrates that women are less likely than men to be full professors in academic medicine, and in certain surgical subspecialties. Whether sex diffe...

Importance Use of locum tenens physicians has increased in the United States, but information about their quality and costs of care is lacking. Objective To evaluate quality and costs of care among hospitalized Medicare beneficiaries treated by locum tenens vs non–locum tenens physicians. Design, Setting, and Participants A random sample of Medic...

Objectives: Evaluate the characteristics of U.S. physicians who are board certified in cardiology and critical care medicine ("dual-boarded cardiologists"). Design: Retrospective cross-sectional study using a comprehensive database of licensed U.S. physicians linked to Medicare claims. Setting: The United States. Subjects: Dual-boarded cardi...

Background The US government created five-star rating systems to evaluate hospital, nursing homes, home health agency and dialysis centre quality. The degree to which quality is a property of organisations versus geographical markets is unclear. Objectives To determine whether high-quality healthcare service sectors are clustered within US healthc...

Objective: The purpose of this study was to evaluate salary differences between male and female academic radiologists at U.S. medical schools. Materials and methods: Laws in several U.S. states mandate public release of government records, including salary information of state employees. From online salary data published by 12 states, we extract...

Pay-for-performance programs, which seek to better align incentives between insurers and clinicians, are increasingly being used to improve quality without necessarily increasing spending. For example, under Medicare’s hospital value-based payment program, reimbursements are based partly on hospital performance on measures of quality, satisfaction,...

Objectives To investigate whether outcomes of patients who were admitted to hospital differ between those treated by younger and older physicians. Design Observational study. Setting US acute care hospitals. Participants 20% random sample of Medicare fee-for-service beneficiaries aged ≥65 admitted to hospital with a medical condition in 2011-14 and...

Appendix: Supplementary tables

Background: Studies demonstrate that women physicians are less likely than men to be full professors. Comprehensive evidence examining whether sex differences in faculty rank exist in academic cardiology, adjusting for experience and research productivity, is lacking. Therefore, we evaluated for sex differences in faculty rank among a comprehensiv...

Importance: Studies have found differences in practice patterns between male and female physicians, with female physicians more likely to adhere to clinical guidelines and evidence-based practice. However, whether patient outcomes differ between male and female physicians is largely unknown. Objective: To determine whether mortality and readmiss...

Cardiovascular disease is the leading cause of death and disability in the United States, accounting for 1 in 4 deaths and more than $200 billion in direct and indirect costs annually.¹ In July 2016, the Centers for Medicare & Medicaid Services (CMS) proposed a new episode-based payment model for myocardial infarction. This model aims to improve th...

A 72 year-old woman with a distant history of a cryptogenic right middle cerebral artery stroke presented with three days of fatigue, confusion, and recrudescence of old stroke symptoms. . Head and neck imaging demonstrated a small subarachnoid hemorrhage, orbital pseudotumors, cerebellar lesions, and circumferential thickening of the aortic arch a...

Purpose To determine whether there were sex differences in full professorship after accounting for factors known to influence academic advancement. Materials and Methods Institutional review board approval was obtained for this HIPAA-compliant study, with waiver of informed consent. In this cross-sectional study, the authors used a comprehensive 20...

Importance: Limited evidence exists on salary differences between male and female academic physicians, largely owing to difficulty obtaining data on salary and factors influencing salary. Existing studies have been limited by reliance on survey-based approaches to measuring sex differences in earnings, lack of contemporary data, small sample sizes...

Purpose Physicians are often ill-equipped for the leadership activities their work demands. In part, this is due to a gap in traditional medical education. An emergent international network is developing a globally relevant leadership curriculum for postgraduate medical education. The purpose of this article is to share key learnings from this proc...

Objectives: Lipid-lowering therapy (LLT) is suboptimally used in patients with hyperlipidemia in the 2 highest statin benefit groups (SBGs), as categorized by the American College of Cardiology and the American Heart Association. This study estimated the social value of reducing low-density lipoprotein cholesterol (LDL-C) levels by 50% for patient...

The study by Zheng and colleagues1 in this issue of JAMA Internal Medicine documents dramatic changes in the care of coronary artery disease (CAD) in China. From 2001 to 2011, the numbers of coronary artery catheterizations and percutaneous coronary interventions (PCIs) performed in urban Chinese hospitals increased 17-fold and 21-fold, respectivel...

Importance: The proportion of women at the rank of full professor in US medical schools has not increased since 1980 and remains below that of men. Whether differences in age, experience, specialty, and research productivity between sexes explain persistent disparities in faculty rank has not been studied. Objective: To analyze sex differences i...

To compare physician owned hospitals (POHs) with non-POHs on metrics around patient populations, quality of care, costs, and payments. Observational study. Acute care hospitals in 95 hospital referral regions in the United States, 2010. 2186 US acute care hospitals (219 POHs and 1967 non-POHs). Proportions of patients using Medicaid and those from...

Early readmission after percutaneous coronary intervention is an important quality metric, but prediction models from registry data have only moderate discrimination. We aimed to improve ability to predict 30-day readmission after percutaneous coronary intervention from a previously validated registry-based model. We matched readmitted to non-readm...

To the Editor: In the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain), Douglas et al. (April 2 issue)(1) describe the clinical outcome of patients with chest pain and suspected coronary artery disease (CAD) who were assigned to undergo either anatomical testing with the use of coronary computed tomographic angiography (...

Internal medicine (IM) physicians, including residents, assume both formal and informal leadership roles that significantly impact clinical and organizational outcomes. However, most internists lack formal leadership training. In 2013 and 2014, we surveyed all rising second-year IM residents at a large northeastern academic medical center about the...

Accurately predicting the risk of no-show for a scheduled colonoscopy can help target interventions to improve compliance with colonoscopy, and thereby reduce the disease burden of colorectal cancer and enhance the utilization of resources within endoscopy units. We aimed to utilize information available in an electronic medical record (EMR) and en...

Background Effective clinical leadership is associated with better patient care. We implemented and evaluated a pilot clinical leadership course for second year internal medicine residents at a large United States Academic Medical Center that is part of a multi-hospital health system.Methods The course met weekly for two to three hours during July,...

Hospital Value Based Purchasing (VBP) aims to incentivize inpatient providers to delivery high value, as opposed to high volume, health care. The formal mandate of hospitals to provide high value health care through financial incentives marks an important change in Medicare and Medicaid policy. In this opportune review of VBP, we discuss the releva...

New payment methods designed to incentivize more efficient care delivery are accelerating the movement of healthcare providers into organized provider groups. More efficient healthcare delivery requires explicit structuring of care delivery processes around teams of clinicians working toward common patient care goals. Provider organizations accepti...

Public reporting of patient outcomes is an important tool to improve quality of care, but some observers worry that such efforts will lead clinicians to avoid high-risk patients. To determine whether public reporting for percutaneous coronary intervention (PCI) is associated with lower rates of PCI for patients with acute myocardial infarction (MI)...

All clinicians take on leadership responsibilities when delivering care. Evidence suggests that effective clinical leadership yields superior clinical outcomes. However, few residency programs systematically teach all residents how to lead, and many clinicians are inadequately prepared to meet their day-to-day clinical leadership responsibilities....

To head off preventable adverse events related to medication, physicians can take three important steps. First, they should define terms when inquiring about what other medications patients use. Second, they should ask patients how they will use their new medications instead of asking whether they understand the instructions for use. Third, they sh...

To review recent work on disorders related to food use, including food addiction, and to highlight the similarities and differences between food and drugs of abuse. Recent work on food use disorders has demonstrated that the same neurobiological pathways that are implicated in drug abuse also modulate food consumption, and that the body's regulatio...

Tobacco, alcohol, substance abuse, and substance dependency are issues routinely encountered in emergency departments, trauma services, and obstetrics/gynecology clinics. Such issues are frequently encountered within the fields of internal medicine, family practice, and psychiatry as well as by most health care practitioners on a daily basis. Addic...

Two studies compared food availability and prices in large and small stores across neighborhoods of varying income levels in New Haven, Connecticut. The findings suggest that supermarket access in lower-income neighborhoods has improved since 1971, and average food prices are comparable across income areas. Despite this progress, stores in lower-in...