Associations between initial American Board of Internal Medicine certification and maintenance of certification status of attending physicians and in-hospital mortality of patients with acute myocardial infarction or congestive heart failure: a retrospective cohort study of hospitalisations in Pennsylvania, USA

Abstract

ObjectiveTo determine whether internists’ initial specialty certification and the maintenance of that certification (MOC) is associated with lower in-hospital mortality for their patients with acute myocardial infarction (AMI) or congestive heart failure (CHF).DesignRetrospective cohort study of hospitalisations in Pennsylvania, USA, from 2012 to 2017.SettingAll hospitals in Pennsylvania.ParticipantsAll 184 115 hospitalisations for primary diagnoses of AMI or CHF where the attending physician was a self-designated internist.Primary outcome measureIn-hospital mortality.ResultsOf the 2575 physicians, 2238 had initial certification and 820 were eligible for MOC. After controlling for patient demographics and clinical characteristics, hospital-level factors and physicians’ demographic and medical school characteristics, both initial certification and MOC were associated with lower mortality. The adjusted OR for initial certification was 0.835 (95% CI 0.756 to 0.922; p<0.001). Patients cared for by physicians with initial certification had a 15.87% decrease in mortality compared with those cared for by non-certified physicians (mortality rate difference of 5.09 per 1000 patients; 95% CI 2.12 to 8.05; p<0.001). The adjusted OR for MOC was 0.804 (95% CI 0.697 to 0.926; p=0.003). Patients cared for by physicians who completed MOC had an 18.91% decrease in mortality compared with those cared for by MOC lapsed physicians (mortality rate difference of 6.22 per 1000 patients; 95% CI 2.0 to 10.4; p=0.004).ConclusionsInitial certification was associated with lower mortality for AMI or CHF. Moreover, for patients whose physicians had initial certification, an additional advantage was associated with its maintenance.