There may be a significant difference in the treatment of individuals who undergo procedural management for carotid artery stenosis depending on their care system, according to a study published March 1 in JAMA Surgery.

The study, led by Louis L. Nguyen, MD, MBA, MPH, et al., looked at the Department of Defense Military Health System Data Repository for individuals diagnosed with carotid artery stenosis between October 1, 2006 and September 30, 2010. Researchers evaluated the data from 10,579 individuals over the course of a year, and assessed whether the individuals were treated by a fee-for-service physician in the private sector or a salary-based military physician.

The results of the study show that of the total diagnosed, 12.4 percent underwent a carotid intervention. The primary outcome – the odds of procedural intervention based on treatment system – was higher in the fee-for-service system compared to those in the salary-based setting (odds ratio, 1.629; 95 percent CI, 1.285-2.063; P < .001). In addition, the findings did not change when the individuals were stratified by symptom status at presentation.

“Although it is difficult to capture fully the factors that motivate patients and clinicians, with respect to the management of carotid stenosis by surgeons and other interventionists, our results do appear to support the conclusion that provider-induced demand … may be at work,” the authors explain. They add that moving forward, “further analysis of the appropriateness of care and noncompensation incentives may improve our understanding of the role between incentives and health care use.”

In an accompanying editorial comment, Ravinder Kang, MD, MS, et al., praise the effect of clinical registries for this data and state that in the future, “richer, more complete data sources will ensure that the surgeons and leaders whom measure appropriateness can make the most data-driven and ‘beautiful’ decisions – no matter who is paying the bill.”

Keywords: Carotid Stenosis, Information Storage and Retrieval, Military Facilities, Military Personnel, Motivation, Private Sector, Registries, Salaries and Fringe Benefits, Surgeons

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