{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T08:02:05Z","timestamp":1778227325800,"version":"3.51.4"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2011,1]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>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 \u03b2-blockers to ambulatory postmyocardial infarction (MI) patients was influenced by physician and patient level characteristics.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\u03b2-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 \u03b2-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 \u03b2-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 \u03b2-blocker prescription, physician factors accounted for only 5% to 8% of the variance in \u03b2-blocker prescription; the preponderance of the variance, 92% to 95%, was at the patient level. The mean physician-specific probability of \u03b2-blocker prescription (95% confidence interval) in the fully adjusted model was 63% (61% to 65%).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>\u03b2-Blocker prescription rates were surprisingly low. The contribution of physician factors to overall variability in \u03b2-blocker prescription, however, was limited. Increasing evidence-based use of \u03b2-blockers may not be accomplished by focusing mostly on differential performance across physicians.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.110.942318","type":"journal-article","created":{"date-parts":[[2010,12,8]],"date-time":"2010-12-08T04:07:14Z","timestamp":1291781234000},"page":"99-106","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Physician and Patient Influences on Provider Performance"],"prefix":"10.1161","volume":"4","author":[{"given":"Ellen","family":"Funkhouser","sequence":"first","affiliation":[{"name":"From the VA Research Enhancement Award Program (E.F., J.R.), Birmingham VA Medical Center, Birmingham, Ala; the Department of Medicine (E.F., J.R., D.A.L.), University of Alabama at Birmingham School of Medicine, Birmingham, Ala; the Center for Outcomes and Effectiveness Research and Education (E.F., J.R.), University of Alabama at Birmingham, Birmingham, Ala; the Department of Quantitative Health Sciences (T.K.H., J.J.A., C.I.K.), University of Massachusetts Medical School, Worcester, Mass; and VA..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas K.","family":"Houston","sequence":"additional","affiliation":[{"name":"From the VA Research Enhancement Award Program (E.F., J.R.), Birmingham VA Medical Center, Birmingham, Ala; the Department of Medicine (E.F., J.R., D.A.L.), University of Alabama at Birmingham School of Medicine, Birmingham, Ala; the Center for Outcomes and Effectiveness Research and Education (E.F., J.R.), University of Alabama at Birmingham, Birmingham, Ala; the Department of Quantitative Health Sciences (T.K.H., J.J.A., C.I.K.), University of Massachusetts Medical School, Worcester, Mass; and VA..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah A.","family":"Levine","sequence":"additional","affiliation":[{"name":"From the VA Research Enhancement Award Program (E.F., J.R.), Birmingham VA Medical Center, Birmingham, Ala; the Department of Medicine (E.F., J.R., D.A.L.), University of Alabama at Birmingham School of Medicine, Birmingham, Ala; the Center for Outcomes and Effectiveness Research and Education (E.F., J.R.), University of Alabama at Birmingham, Birmingham, Ala; the Department of Quantitative Health Sciences (T.K.H., J.J.A., C.I.K.), University of Massachusetts Medical School, Worcester, Mass; and VA..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Richman","sequence":"additional","affiliation":[{"name":"From the VA Research Enhancement Award Program (E.F., J.R.), Birmingham VA Medical Center, Birmingham, Ala; the Department of Medicine (E.F., J.R., D.A.L.), University of Alabama at Birmingham School of Medicine, Birmingham, Ala; the Center for Outcomes and Effectiveness Research and Education (E.F., J.R.), University of Alabama at Birmingham, Birmingham, Ala; the Department of Quantitative Health Sciences (T.K.H., J.J.A., C.I.K.), University of Massachusetts Medical School, Worcester, Mass; and VA..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeroan J.","family":"Allison","sequence":"additional","affiliation":[{"name":"From the VA Research Enhancement Award Program (E.F., J.R.), Birmingham VA Medical Center, Birmingham, Ala; the Department of Medicine (E.F., J.R., D.A.L.), University of Alabama at Birmingham School of Medicine, Birmingham, Ala; the Center for Outcomes and Effectiveness Research and Education (E.F., J.R.), University of Alabama at Birmingham, Birmingham, Ala; the Department of Quantitative Health Sciences (T.K.H., J.J.A., C.I.K.), University of Massachusetts Medical School, Worcester, Mass; and VA..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catarina I.","family":"Kiefe","sequence":"additional","affiliation":[{"name":"From the VA Research Enhancement Award Program (E.F., J.R.), Birmingham VA Medical Center, Birmingham, Ala; the Department of Medicine (E.F., J.R., D.A.L.), University of Alabama at Birmingham School of Medicine, Birmingham, Ala; the Center for Outcomes and Effectiveness Research and Education (E.F., J.R.), University of Alabama at Birmingham, Birmingham, Ala; the Department of Quantitative Health Sciences (T.K.H., J.J.A., C.I.K.), University of Massachusetts Medical School, Worcester, Mass; and VA..."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.23.3003"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.118.2_suppl.53S"},{"key":"e_1_3_4_4_2","first-page":"CD000259","article-title":"Audit and feedback: effects on professional practice and health care outcomes","author":"Jamtvedt G","year":"2006","unstructured":"Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD . 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