University of Minnesota Ph.D. dissertation.June 2017. Major: Health Services Research, Policy and Administration. Advisors: Pinar Karaca-Mandic, Roger Feldman. 1 computer file (PDF); xi, 211 pages.Physicians often deliver procedures in more than 1 hospital. A consequence of this behavior is the physician has to work with more hospital teams, which reduces the shared experience between physicians and hospitals, limits the availability of physicians before and after procedures, and potentially reduces the mutual investments physicians and hospitals make to improve the quality of their service lines. These factors could increase the risk of medical errors being made during a patient’s hospital stay and contribute in other ways to adverse patient outcomes. The objective of this study is to accurately estimate the relation between multihospital practice by interventional cardiologists delivering percutaneous coronary interventions (PCI) and patient injuries and death following PCI. I find that multihospital practice holds a significant relation with patient mortality after PCI. Inhospital death rates are 17.3% higher (1.61% to 1.89%; p < .05) among physicians most likely to have a multihospital practice (i.e., the highest quartile of predicted multihospital probability) compared to those least likely to (lowest quartile). Evidence suggests that this relation is due to the availability of the physician before PCI, which creates longer times-to-treatment for emergent patients. In addition, I find that physician experience holds an inverse relation with patient injuries due to medical error. Multihospital practice will influence patient injuries from medical error if it substantially changes the physician’s procedure experience
