Special Article
Knowledge and Practices of Generalist and Specialist Physicians Regarding Drug Therapy for Acute Myocardial Infarction
N Engl J Med 1994; 331:1136-1142October 27, 1994
- Abstract
Background
The respective roles of generalist and specialist physicians in the care of patients are currently a matter of debate. Information is limited about the knowledge and practices of generalist and specialist physicians regarding conditions that both groups treat, such as myocardial infarction.
Methods
We therefore surveyed 1211 cardiologists, internists, and family practitioners in the states of New York and Texas about four treatments demonstrated by randomized clinical trials to be associated with improved survival after myocardial infarction (thrombolytic therapy, immediate and long-term use of aspirin, and long-term use of beta-blockers) and two treatments for which such evidence is lacking (diltiazem for patients with pulmonary congestion and prophylactic lidocaine). We asked physicians about the effect of each treatment on survival and the likelihood that they would prescribe each class of drugs.
Results
For the four beneficial treatments, the cardiologists believed more strongly than the internists and family physicians that survival was improved by the treatment, and they were more likely to prescribe these drugs (P<0.001). For example, 94.1 percent of cardiologists said they were very likely to prescribe thrombolytic agents to treat an acute myocardial infarction, as compared with 82.0 percent of internists and 77.3 percent of family practitioners. Conversely, for the two treatments for which trials showed no evidence of a survival benefit, cardiologists were less likely than internists and family practitioners to think there was such a benefit and less likely to prescribe the drugs (P<0.001). For example, 4.7 percent of cardiologists reported that they were very likely to use prophylactic lidocaine, as compared with 13.1 percent of internists, and 16.5 percent of family practitioners. When we used logistic regression to adjust for potential confounders, all the differences between the cardiologists and the internists and family practitioners remained significant (P<0.02).
Conclusions
Internists and family practitioners are less aware of or less certain about key advances in the treatment of myocardial infarction than are cardiologists. This finding underscores the need to improve the dissemination of information from clinical trials to generalist physicians, particularly if they are to have an enlarged role in the evolving health care system.
Media in This Article
Figure 1
Proportion of Physicians Who Reported That They Were Very Likely to Prescribe Beta-Blockers as Long-Term Therapy for Patients under 75 Years of Age with Acute Myocardial Infarction, According to State and Field of Practice.Table 1
Characteristics of the Responding Physicians According to State and Field of Practice.Article Activity
- Article
The appropriate role of generalist and specialist physicians is a major issue in the debate about the health care system of the United States1-3. Over two thirds of physicians in the United States are specialists,4 but managed-care plans use considerably fewer of them5,6. Recently, national debate has focused on ways to increase the proportion of physicians who deliver primary care,7,8 with the goals of improving access, containing costs, and maintaining the quality of care2. Little is known, however, about the knowledge and practices of generalist and specialist physicians with respect to the treatment of specific illnesses.
Myocardial infarction is an illness for which both generalists and specialists deliver care. It is the leading cause of death in the United States9 and accounts for nearly 700,000 hospital discharges annually10. Therefore, physicians' treatment of myocardial infarction is an important model for assessing the knowledge and practices of generalist physicians in the fields of family medicine and internal medicine as compared with those of specialists in the field of cardiology.
Over the past 30 years, randomized, controlled trials of drug therapy have produced valuable new insights into the treatment of myocardial infarction11,12. Such trials have demonstrated clear improvements in survival associated with the use of thrombolytic agents,13,14 aspirin,14,15 and beta-blockers16-18 in patients with myocardial infarction. Conversely, randomized trials have not shown improvements in survival with the prophylactic use of lidocaine19,20 or the use of calcium-channel blockers21-24 for this condition. Physicians at hospitals that participate in clinical trials may rapidly apply the results of such trials in their practices,25,26 but data from broader samples of hospitals have shown that thrombolytic agents are still used in a relatively small proportion of patients after myocardial infarction and that calcium-channel blockers are used more frequently than beta-blockers27,28.
Previous surveys of physicians have suggested that the prescription practices of internists and family practitioners differ from those of cardiologists,29,30 but this finding has not been uniform31. We surveyed physicians in the states of New York and Texas who had recently treated patients with acute myocardial infarction to assess their knowledge and practices regarding drug therapy for this condition.
Methods
Study Population
We selected New York and Texas because they are large states (together they account for 14 percent of the U.S. population32), they are in different regions of the country, and they are the focus of an extensive analysis of the costs and outcomes of acute myocardial infarction by us and others. These two states also have different patterns of care for patients with myocardial infarction; for example, coronary angiography is used much more frequently to assess patients with myocardial infarction in Texas than in New York (unpublished data).
We obtained the names and addresses of all licensed cardiologists, internists, and family practitioners from the Medical Society of the State of New York (including both members and nonmembers of the society) and the Texas State Board of Medical Examiners as of January 1993. These organizations update their records through regular contact with physicians and other professional organizations. Before sampling, we excluded physicians who were listed as retired or in training or who practiced outside the two states. The remaining physicians, available for sampling, included 1458 cardiologists, 6863 internists, and 1976 family practitioners in New York and 619 cardiologists, 3068 internists, and 3346 family practitioners in Texas.
Physicians were considered eligible if they reported serving as the attending or consulting physician for at least one patient hospitalized with acute myocardial infarction during the three months before the survey. Our objective was to obtain completed surveys from at least 1000 eligible physicians, roughly half from each state and one third from each of the three fields. This sample would provide the study with a statistical power of 80 percent to detect an absolute difference of 15 percent in responses between any two fields of practice within one state.
To estimate eligibility and response rates before the full sample was surveyed, we initially distributed the questionnaire to a randomly selected subsample of 389 physicians. The total random sample of 4386 physicians (including the initial 389 physicians) comprised 348 cardiologists, 848 internists, and 974 family practitioners in New York and 316 cardiologists, 788 internists, and 1112 family practitioners in Texas.
Data Collection
We designed a four-page questionnaire to assess physicians' knowledge about and practices regarding drug therapy for myocardial infarction. We inquired about four treatments in association with which randomized trials published in major clinical journals have demonstrated clear improvements in overall survival; they were thrombolytic agents administered within 6 hours of the onset of myocardial infarction,13,14 aspirin initiated within 24 hours14 and continued as long-term therapy,15 and the long-term use of beta-blockers16-18. We also inquired about two treatments that have not been shown to improve survival in randomized trials and that may actually reduce survival: prophylactic administration of lidocaine within 24 hours after the onset of myocardial infarction19,20 and diltiazem for patients with Q-wave myocardial infarctions and pulmonary congestion23,24.
We elicited each physician's beliefs about the effect of specific treatments on overall survival among patients under 75 years of age, based on reported studies. We chose this age limit because published data are less extensive for older patients than for younger ones. We asked the physicians to choose one of five terms to describe the effect of the four treatments: “definitely improve survival,” “probably improve survival,” “no clear effect on survival,” “probably worsen survival,” and “definitely worsen survival”; or to answer “not sure.” We also asked physicians to rate the likelihood that they would use each class of drug in patients under 75 years of age with acute myocardial infarction. The choices were “very likely,” “somewhat likely,” “unlikely,” “do not use after myocardial infarction,” and “not sure.”
We also collected demographic and professional data from the physicians, including their age and sex, whether they had board certification in their primary field of practice, the number of patients they had treated for acute myocardial infarction during the preceding three months, and the number of beds and teaching status of the hospital where they chiefly practiced.
The survey was distributed to the physicians by Northeast Research, a survey firm in Orono, Maine, along with a letter from one of us describing the purpose of the survey, the federal funding, and the voluntary and confidential nature of the survey. Physicians who did not respond to the initial mailing within three weeks received a second questionnaire by certified mail. The staff of Northeast Research called physicians who did not respond to the mailings, making at least eight telephone calls over a 15-day period to determine each physician's eligibility and willingness to complete the survey. Finally, a third mailing was sent to physicians who did not respond within four weeks of the last attempted call.
Eligibility and Response Rates
Of the 4386 physicians to whom we sent questionnaires, 12 had died. The remaining group of 4374 physicians were in the following categories: (a) 1211 were eligible and completed the survey; (b) 319 were eligible but declined to respond or did not return the survey; (c) 1818 returned the survey but were ineligible; and (d) 1026 had unknown eligibility and did not return the survey. On the basis of the 3348 physicians whose eligibility was known (categories a + b + c), we estimate that 45.7 percent of sampled physicians were eligible for the study [(a + b) divided by (a + b + c)]. When this eligibility rate was applied to the physicians with unknown eligibility (category d), the overall response rate was 60.6 percent33.
The eligibility rates according to field of practice in New York and Texas were 79.5 percent and 89.7 percent, respectively, for cardiologists; 40.3 percent and 41.8 percent for internists; and 40.9 percent and 32.9 percent for family practitioners. Among the eligible physicians, the response rates according to field in New York and Texas were 64.7 percent and 65.0 percent, respectively, for cardiologists, 54.1 percent and 61.1 percent for internists, and 64.2 percent and 57.3 percent for family practitioners.
In Texas, the 593 physicians who completed the survey were similar to the 637 physicians who did not respond in terms of mean age (both 45.9 years, P = 0.90) and the proportions who were men (92.2 percent vs. 90.1 percent, P = 0.19), who had graduated from medical schools in the United States and Canada (81.4 percent vs. 78.5 percent, P = 0.20), and who were practicing in metropolitan areas (83.3 percent vs. 85.4 percent, P = 0.31). Respondents were slightly more likely than nonrespondents to be non-Hispanic whites (79.4 percent vs. 74.1 percent, P = 0.05). In New York, only the name, address, and specialty of each physician were available to us, so we could not perform similar comparisons of respondents and nonrespondents.
Statistical Analysis
All analyses were performed on data from the 1211 completed surveys from eligible physicians. The demographic and professional characteristics of the physicians in the three fields are presented according to state. For the substantive questions relating to knowledge and practices, the patterns of response according to field of practice were similar in the two states; therefore, data have been combined for the two states in the tables, and results for each state are summarized in the text. Pairwise comparisons between fields were performed with the Wilcoxon rank-sum test. “Not sure” or missing responses to individual items were excluded from these analyses. Such responses were received from fewer than 5 percent of the respondents for each of the substantive questions, except for that related to the effect of diltiazem on survival among patients with a Q-wave myocardial infarction and pulmonary congestion (14.6 percent).
Multiple logistic regression was used to assess the relative likelihood that physicians in each field would believe that the four beneficial treatments definitely improved survival. For the two ineffective treatments, we calculated the relative likelihood that physicians would believe that the treatment probably or definitely improved survival (neither of these responses is supported by published data). We also assessed the odds that physicians in different specialties would be very likely to use each class of drugs to treat patients with myocardial infarction. All models controlled for the age of the physician (<40, 40 through 49, or ≥ 50 years), board certification, the number of patients treated for myocardial infarction in the past three months (1 through 4, 5 through 9, or ≥ 10), and the number of beds (<200, 200 through 499, and ≥ 500) in the principal hospital in which the physician treated patients for myocardial infarction and its teaching status (university, university-affiliated, or community hospital).
Analyses were conducted with SAS statistical software34. Individual physicians were identified only by a confidential study number. Two-tailed P values are reported for descriptive statistics and 95 percent confidence intervals for adjusted odds ratios.
Results
Characteristics of the Physicians
The characteristics of the responding physicians in each field are presented in Table 1Table 1
Characteristics of the Responding Physicians According to State and Field of Practice.. In New York, but not in Texas, family practitioners were younger, on average, than physicians in the other two fields and more likely to be board certified in their specialty. As compared with internists and family practitioners, cardiologists in each state had recently treated more patients with acute myocardial infarction. In both states, family practitioners were more likely than cardiologists to work in community hospitals and smaller hospitals; internists occupied an intermediate position between the other two groups.Beliefs about Drugs
For the four drug therapies that are known to increase survival, cardiologists believed more strongly than internists and family practitioners that treatment improved overall survival after myocardial infarction (Table 2Table 2
Beliefs of Physicians in New York and Texas about the Effect of Drugs on Survival among Patients under 75 Years of Age with Acute Myocardial Infarction, According to Field of Practice.). With respect to thrombolytic agents, 93.1 percent of cardiologists believed therapy definitely improved survival, as compared with 85.4 percent of internists and 80.7 percent of family practitioners; for the immediate use of aspirin, these figures were 75.9 percent, 52.4 percent, and 44.7 percent; for the long-term use of aspirin, 71.6 percent, 54.6 percent, and 50.0 percent; and for the long-term use of beta-blockers, 75.3 percent, 54.2 percent, and 51.6 percent. Conversely, for the prophylactic use of lidocaine and the use of diltiazem for patients with Q-wave myocardial infarction and pulmonary congestion, cardiologists were less likely than internists and family practitioners to believe these treatments improved survival. Among cardiologists, 10.9 percent thought that prophylactic lidocaine definitely or probably improved survival, as compared with 34.0 percent of internists and 40.2 percent of family practitioners; for the use of diltiazem, these figures were 2.3 percent, 5.8 percent, and 16.5 percent. As shown in Table 2, beliefs about the efficacy of drugs did not differ significantly between internists and family practitioners, except for the immediate use of aspirin (P<0.03) and the use of diltiazem for patients with Q-wave myocardial infarctions and pulmonary congestion (P<0.001). In both cases, internists' beliefs fell between those of cardiologists and family practitioners.In analyses stratified according to state, the differences between cardiologists and the other two groups of physicians were significant (P<0.05) in both New York and Texas for all but one of the six therapies. In Texas, internists were similar to cardiologists in their beliefs about the effects of early thrombolytic therapy (P>0.10).
In the logistic-regression models, the field of practice remained a significant predictor of beliefs (Table 3Table 3
Adjusted Odds Ratios for Beliefs about the Effect of Drugs on Survival, According to Field of Practice.). After we adjusted for age, the number of patients treated recently who had acute myocardial infarction, the hospital's size and teaching status, and the state, cardiologists were more likely than both internists and family practitioners to respond that early thrombolytic therapy, the immediate and long-term use of aspirin, and the long-term use of beta-blockers definitely improved survival. Cardiologists were less likely than the physicians in the other two groups to believe that prophylactic lidocaine and diltiazem definitely or probably improved survival.Age was a significant predictor of beliefs in the multivariate model. Physicians under 40 years of age were more likely than older physicians to believe in the value of the four therapies that genuinely improve survival and less likely to believe in the value of prophylactic lidocaine and diltiazem (P ≤ 0.05). Board certification, the number of patients with myocardial infarction that each physician had treated recently, and the size and teaching status of each physician's principal hospital were not consistently significant predictors in the logistic-regression models.
Prescription Practices
The physicians' reports of their prescription practices were consistent with their beliefs about the effects on survival of each class of drugs (Table 4Table 4
Drug-Prescription Practices of Physicians in New York and Texas Treating Patients under 75 Years of Age with Acute Myocardial Infarction, According to Field of Practice.). Cardiologists were more likely than internists and family practitioners to state that they would prescribe thrombolytic agents (94.1 percent said they were very likely to prescribe such agents, as compared with 82.0 percent and 77.3 percent, respectively), aspirin (98.7 percent, 91.3 percent, and 89.8 percent), and beta-blockers (77.5 percent, 63.0 percent, and 53.1 percent) for patients with acute myocardial infarction; cardiologists were least likely to report that they would use prophylactic lidocaine (4.7 percent, 13.1 percent, and 16.5 percent) and calcium-channel blockers (11.2 percent, 22.6 percent, and 26.0 percent). All these differences were significant (P ≤ 0.05) in stratified analyses in each state and in multivariate analyses (Table 5Table 5
Adjusted Odds of Prescribing Specific Drugs for Patients with Myocardial Infarction, According to Field of Practice.).In the full sample (Table 4), internists were more likely than family practitioners to report prescribing beta-blockers (P<0.01), a difference that was significant in each state (P<0.05). Internists were less likely than family practitioners to report prescribing prophylactic lidocaine when we analyzed the full sample (P<0.02), but this finding was significant only in Texas (P<0.001), not in New York.
Use of Beta-Blockers
Beliefs and practices were generally similar among physicians in the two states, but within each field of practice more physicians in New York than in Texas believed that beta-blockers definitely improved survival (P<0.05). Accordingly, for each specialty, a larger proportion of physicians in New York than in Texas reported that they were very likely to prescribe beta-blockers (P<0.001); the proportions ranged widely, from 88 percent of cardiologists in New York to 37 percent of family practitioners in Texas (Figure 1Figure 1
Proportion of Physicians Who Reported That They Were Very Likely to Prescribe Beta-Blockers as Long-Term Therapy for Patients under 75 Years of Age with Acute Myocardial Infarction, According to State and Field of Practice.). The state was a significant predictor of beliefs and practices regarding beta-blockers in the multivariate models (P<0.001).Discussion
Our survey of physicians in New York and Texas demonstrates that internists and family practitioners are less aware than cardiologists of the results of studies of the effect of important drugs on survival after myocardial infarction, or less certain about such results. Most striking was the finding that only about half of internists and family practitioners believed that the immediate and long-term use of aspirin and the long-term use of beta-blockers definitely improved survival, as compared with roughly three quarters of cardiologists. These variations in beliefs were associated with significant differences among the fields in the prescription of each class of drugs, and the patterns were consistent in each state.
Three factors may explain the differences in beliefs and practices between generalist and specialist physicians. First, internists and family practitioners may have less knowledge than cardiologists of the results of key clinical trials. Physicians maintain and refine their clinical knowledge by reading journals and textbooks, through discussions with colleagues, and through participation in conferences and continuing-education courses35-37. Cardiologists are better able than primary care physicians to focus their learning by these methods on myocardial infarction, since cardiologists treat patients for a narrower range of clinical problems than do internists or family practitioners. The major published guidelines for the treatment of myocardial infarction in the United States have appeared in journals that target cardiologists38,39; primary care physicians may also benefit from such guidelines.
A second explanation could be that physicians in generalist fields have greater concern about therapeutic complications, such as bleeding after thrombolytic therapy or congestive heart failure due to beta-blockers. Probably because aspirin is viewed as the most benign of the drugs in this study, 9 out of 10 internists and family practitioners who responded said they were very likely to prescribe aspirin after myocardial infarction -- even though only half believed that it definitely improved survival. However, this factor does not explain the greater willingness of internists and family practitioners to use prophylactic lidocaine and calcium-channel blockers, both of which can have important and occasionally lethal side effects.
A third explanation could be that generalist physicians may exercise greater caution than specialists in accepting new data or changing established patterns of treatment40. Some cardiologists may share this caution, as demonstrated by the one quarter who said they did not believe that aspirin and beta-blockers definitely improved survival after myocardial infarction. Even clinical experts can be slow to incorporate the results of clinical trials into their published recommendations41.
The relation of the age of physicians to their beliefs about drug therapy suggests that younger physicians have had more recent or more concentrated exposure to the results of relevant clinical trials than older physicians or that they may be more receptive to new standards of practice42. Physicians in New York were more likely than those in Texas to say they believed that beta-blockers improved survival after myocardial infarction and to use them for patients with this condition; this finding supports other studies that have demonstrated geographic variations in medical care43,44. The number of patients that each physician had recently treated for myocardial infarction was not a consistently significant predictor in the multivariate models. However, our ability to assess this variable was limited because it was closely correlated with field of practice.
Our study had several strengths. We found consistent results in a large sample of physicians from two regions of the United States. We focused on physicians who had recently treated patients for acute myocardial infarction, and the response rate was substantially higher than in other published surveys of physicians,30,45 thus reducing the possibility of bias related to the characteristics of nonrespondents.
This study has at least three limitations. First, the data on prescription practices are based on reports by physicians, not data from medical records. Second, some physicians may have based their answers on the limited clinical detail provided in the survey questions. For example, specifying the presence of ST-segment elevation might more accurately elicit beliefs about the effect of thrombolytic therapy on survival, and specifying the level of ventricular function might influence the responses to questions about the likelihood of prescribing calcium-channel blockers. Third, we expect that more appropriate use of drugs results in better clinical outcomes,46 but our data do not address this issue. In preliminary data from a study of patients with unstable angina, internists were less likely than cardiologists to use aspirin and beta-blockers in clinical practice, and mortality among patients treated by internists tended to be higher47.
Many internists and family practitioners are aware of the results of published clinical trials and meta-analyses of therapy for myocardial infarction and apply these results in their practices. On average, however, generalist physicians appear to be less aware of or less certain about these results than are specialists. A number of factors may improve the knowledge and practice patterns of physicians,48,49 including continuing-education programs, broader dissemination of guidelines, more rigorous recertification procedures, provision of feedback about clinical practices, and participation in community-based clinical trials. A multifaceted approach to increasing physicians' knowledge of trial results will help to ensure that important lessons from research are applied to medical care in an appropriate and timely manner.
Supported by a Patient Outcomes Research Team grant (HS06341) from the Agency for Health Care Policy and Research. Dr. Ayanian is a Generalist Physician Faculty Scholar of the Robert Wood Johnson Foundation.
We are indebted to Michael Elliott and David Kovenock of Northeast Research for administering the survey, to Alison Eastwood and Bud Davies for statistical programming, to Brian Egleston for assistance in the preparation of the manuscript, and to Anthony L. Komaroff, M.D., and Thomas J. Ryan, M.D., for helpful comments on an earlier draft of the manuscript.
Source Information
From the Division of General Medicine, Section on Health Services and Policy Research (J.Z.A.), and the Cardiovascular Division (P.J.H., E.M.A.) of the Department of Medicine, and the Department of Radiology (B.J.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, and the Department of Health Care Policy, Harvard Medical School, Boston (J.Z.A., E.G., C.L.P., B.J.M.).
Address reprint requests to Dr. Ayanian at the Department of Health Care Policy, Harvard Medical School, 25 Shattuck St., Parcel B, 1st Fl., Boston, MA 02115.
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Citing Articles
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Lillian C. Min, David B. Reuben, Emmett Keeler, David A. Ganz, Constance H. Fung, Paul Shekelle, Carol P. Roth, Neil S. Wenger. (2011) Is Patient-Perceived Severity of a Geriatric Condition Related to Better Quality of Care?. Medical Care 49:1, 101-107
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James P Guevara, Diane Hsu, Christopher B Forrest. (2011) Performance measures of the specialty referral process: a systematic review of the literature. BMC Health Services Research 11:1, 168
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John M. Hollingsworth, Brent K. Hollenbeck, Stephanie Daignault, Simon P. Kim, John T. Wei. (2009) Differences in Initial Benign Prostatic Hyperplasia Management Between Primary Care Physicians and Urologists. The Journal of Urology 182:5, 2410-2414
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Giuseppe Marano, Desiree Harnic, Marzia Lotrionte, Giuseppe Biondi-Zoccai, Antonio Abbate, Enrico Romagnoli, Marianna Mazza. (2009) Depression and the cardiovascular system: increasing evidence of a link and therapeutic implications. Expert Review of Cardiovascular Therapy 7:9, 1123-1147
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Peter Zweifel, Ming Tai-Seale. (2009) An economic analysis of payment for health care services: The United States and Switzerland compared. International Journal of Health Care Finance and Economics 9:2, 197-210
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Michael A. Vogelbaum, Anthony L. Asher, Douglas Kondziolka, Nicholas M. Boulis, Nathan R. Selden, Brian L. Hoh, Fred G. Barker. (2009) Modern treatment of cerebral metastases: Integrated Medical LearningSM at CNS 2007. Journal of Neuro-Oncology 93:1, 89-105
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Aristides Assimacopoulos, Rabiul Alam, Manuel Arbo, Jawad Nazir, Ding-Geng Chen, Susan Weaver, Marilyn Dahler-Penticoff, Karla Knobloch, Mary DeVany, Cheryl Ageton. (2008) A Brief Retrospective Review of Medical Records Comparing Outcomes for Inpatients Treated via Telehealth Versus In-Person Protocols: Is Telehealth Equally Effective as In-Person Visits for Treating Neutropenic Fever, Bacterial Pneumonia, and Infected Bacterial Wounds?. Telemedicine and e-Health 14:8, 762-768
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Marcia J. Jackson, Harry A. Gallis, Stuart C. Gilman, Michael Grossman, Gerald B. Holzman, Damon Marquis, Sandra K. Trusky. (2008) The need for specialty curricula based on core competencies: A white paper of the conjoint committee on continuing medical education. Journal of Continuing Education in the Health Professions 27:2, 124-128
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Paul J. Hauptman, Jason Swindle, Zainal Hussain, Lois Biener, Thomas E. Burroughs. (2008) Physician Attitudes Toward End-Stage Heart Failure: A National Survey. The American Journal of Medicine 121:2, 127-135
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Brahmajee K. Nallamothu, Martha E. Blaney, Susan M. Morris, Lori Parsons, Dave P. Miller, John G. Canto, Hal V. Barron, Harlan M. Krumholz. (2007) Acute Reperfusion Therapy in ST-Elevation Myocardial Infarction from 1994-2003. The American Journal of Medicine 120:8, 693.e1-693.e8
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Tim Doran, Gillian Maudsley, Hani Zakhour. (2007) Time to think? Questionnaire survey of pre-registration house officers' experiences of critical appraisal in the Mersey Deanery. Medical Education 41:5, 487-494
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Kari Swarztrauber, Eric Graf. (2007) Nonphysicians' and physicians' knowledge and care preferences for Parkinson's disease. Movement Disorders 22:5, 704-707
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Andrew D. Auerbach, Richard Chlouber, Jennifer Singler, Jon D. Lurie, Alan Bostrom, Robert M. Wachter. (2006) Trends in Market Demand for Internal Medicine 1999 to 2004: An Analysis of Physician Job Advertisements. Journal of General Internal Medicine 21:10, 1079-1085
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K KHAN. (2006) The architecture of evidence-based gynaecology
. Best Practice & Research Clinical Obstetrics & Gynaecology 20:5, 639-646
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Stephen Gottlieb, Kay Blum. (2006) Coordinated Care, Telemonitoring, and the Therapeutic Relationship: Heart Failure Management in the United States. Disease Management & Health Outcomes 14:Suppl 1, 29???31
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Alan P. Baptist, Tricia S. Tang, Linping Duan, James L. Baldwin. (2005) Elective Rotations and Their Impact on Resident and Faculty Decision Making. Teaching and Learning in Medicine 17:4, 332-336
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J. Turumbay, C. Moreno-Iribas, J.R. Carmona, E. Alegría, I. Ezpeleta, A. Manrique. (2005) Diferencias en el manejo del infarto agudo de miocardio según la edad en los hospitales de Navarra. Estudio IBERICA. Revista Española de Geriatría y Gerontología 40:4, 205-213
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Kevin E. McVaney, Marlow Macht, Christopher B. Colwell, Peter T. Pons. (2005) Treatment of Suspected Cardiac Ischemia with Aspirin by Paramedics in an Urban Emergency Medical Services System. Prehospital Emergency Care 9:3, 282-284
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A. Vallano, E. Montan
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Adesuwa B. Olomu, Ralph E. Watson, Azfar-e-Alam Siddiqi, Francesca C. Dwamena, Barbara A. McIntosh, Peter Vasilenko, Joel Kupersmith, Margaret M. Holmes-Rovner, . (2004) Changes in Rates of Beta-blocker Use in Community Hospital Patients with Acute Myocardial Infarction. Journal of General Internal Medicine 19:10, 999-1004
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S. Vikman, K. E. J. Airaksinen, I. Tierala, K. Peuhkurinen, K. Majamaa-Voltti, M. Niemela, H. Tuunanen, M. S. Nieminen, K. Niemela. (2004) Improved adherence to practice guidelines yields better outcome in high-risk patients with acute coronary syndrome without ST elevation: findings from nationwide FINACS studies. Journal of Internal Medicine 256:4, 316-323
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Helen M. MacRae, Glenn Regehr, Marg McKenzie, Harry Henteleff, Mark Taylor, Jeff Barkun, G.William Fitzgerald, Andrew Hill, Carole Richard, Eric M. Webber, Robin S. McLeod. (2004) Teaching practicing surgeons critical appraisal skills with an Internet-based journal club: a randomized, controlled trial. Surgery 136:3, 641-646
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Bertram Pitt. (2004) Generic drugs in cardiology: will they reduce health care costs?. Journal of the American College of Cardiology 44:1, 10-13
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Kari Swarztrauber, Barbara G. Vickrey. (2004) Do Neurologists and Primary Care Physicians Agree on the Extent of Specialty Involvement of Patients Referred to Neurologists?. Journal of General Internal Medicine 19:6, 654-661
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Timothy P. Hofer, Judith K. Zemencuk, Rodney A. Hayward. (2004) When there is too much to do. Journal of General Internal Medicine 19:6, 646-653
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Sumit R. Majumdar, Finlay A. McAlister, Curt D. Furberg. (2004) From knowledge to practice in chronic cardiovascular disease: a long and winding road. Journal of the American College of Cardiology 43:10, 1738-1742
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P.Michael Ho, Frederick A Masoudi, Eric D Peterson, Gary K Grunwald, Anne E Sales, Karl E Hammermeister, John S Rumsfeld. (2004) Cardiology management improves secondary prevention measures among patients with coronary artery disease. Journal of the American College of Cardiology 43:9, 1517-1523
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Peter K Henke, Susan Blackburn, Mary C Proctor, Jeri Stevens, Debabrata Mukherjee, Sanjay Rajagopalin, Gilbert R Upchurch, James C Stanley, Kim A Eagle. (2004) Patients undergoing infrainguinal bypass to treat atherosclerotic vascular disease are underprescribed cardioprotective medications: effect on graft patency, limb salvage, and mortality. Journal of Vascular Surgery 39:2, 357-365
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Kanika Kapur, José J. Escarce. (2003) Effect of Primary Care Visits on the Demand for Specialty Care in Health Maintenance Organizations. Health Services and Outcomes Research Methodology 4:4, 203-219
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Jos
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John A Spertus, Martha J Radford, Nathan R Every, Edward F Ellerbeck, Eric D Peterson, Harlan M Krumholz. (2003) Challenges and opportunities in quantifying the quality of care for acute myocardial infarction. Journal of the American College of Cardiology 41:9, 1653-1663
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Bruce E. Landon, Ira B. Wilson, Susan E. Cohn, Carl J. Fichtenbaum, Mitchell D. Wong, Neil S. Wenger, Samuel A. Bozzette, Martin F. Shapiro, Paul D. Cleary. (2003) Physician Specialization and Antiretroviral Therapy for HIV. Adoption and Use in a National Probability Sample of Persons Infected With HIV. Journal of General Internal Medicine 18:4, 233-241
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Dawn Provenzale, Joshua Ofman, Ian Gralnek, Linda Rabeneck, Raymond Koff, Douglas McCrory. (2003) Gastroenterologist specialist care and care provided by generalists-an evaluation of effectiveness and efficiency. The American Journal of Gastroenterology 98:1, 21-28
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Richard P. Lewis. (2003) Crunch Time for Clinical Cardiology. The American Heart Hospital Journal 1:1, 104-106
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Ali Ahmed, Richard V. Sims, Richard M. Allman, James F. DeLong, Wilbert S. Aronow. (2003) Racial Variations in Cardiology Care Among Hospitalized Older Heart Failure Patients. Heart Disease 5:1, 8-14
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S. Joffe. (2002) Views of American Oncologists About the Purposes of Clinical Trials. CancerSpectrum Knowledge Environment 94:24, 1847-1853
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Kari Swarztrauber, Barbara G. Vickrey, Brian S. Mittman. (2002) Physicians’ Preferences for Specialty Involvement in the Care of Patients With Neurological Conditions. Medical Care 40:12, 1196-1209
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Mary Mc Grae McDermott, Elizabeth A. Hahn, Philip Greenland, David Cella, Judith K. Ockene, Donna Brogan, William H. Pearce, Alan T. Hirsch, Kendra Hanley, Linda Odom, Shaheen Khan, Michael H. Criqui, Martin S. Lipsky, Stacie Hudgens. (2002) Atherosclerotic Risk Factor Reduction in Peripheral Arterial Disease. Results of a National Physician Survey. Journal of General Internal Medicine 17:12, 895-904
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Ayanian, John Z., Landrum, Mary Beth, Guadagnoli, Edward, Gaccione, Peter, . (2002) Specialty of Ambulatory Care Physicians and Mortality among Elderly Patients after Myocardial Infarction. New England Journal of Medicine 347:21, 1678-1686
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John E. Calfee. (2002) Public Policy Issues in Direct-to-Consumer Advertising of Prescription Drugs. Journal of Public Policy & Marketing 21:2, 174-193
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Ali Ahmed. (2002) Quality and Outcomes of Heart Failure Care in Older Adults: Role of Multidisciplinary Disease-Management Programs. Journal of the American Geriatrics Society 50:9, 1590-1593
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Rajendra H Mehta, Douglas A Criger, Christopher B Granger, Karen K Pieper, Robert M Califf, Eric J Topol, Eric R Bates. (2002) Patient outcomes after fibrinolytic therapy for acute myocardial infarction at hospitals with and without coronary revascularization capability. Journal of the American College of Cardiology 40:6, 1034-1040
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Usha Sambamoorthi, Ayse Akincigil, Elizabeth McSpiritt, Stephen Crystal. (2002) Zidovudine Use During Pregnancy Among HIV-Infected Women on Medicaid. JAIDS Journal of Acquired Immune Deficiency Syndromes 30:4, 429-439
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Terry S. Field, Cynthia A. Cadoret, Martin L. Brown, Marvella Ford, Sarah M. Greene, Deanna Hill, Mark C. Hornbrook, Richard T. Meenan, Mary Jo White, Jane M. Zapka. (2002) Surveying Physicians. Medical Care 40:7, 596-605
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Harold L Kennedy, Robert S Rosenson. (2002) Physicians’ interpretation of “class effects”. Journal of the American College of Cardiology 40:1, 19-26
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William G. Carnett. (2002) Clinical Practice Guidelines: A Tool To Improve Care. Journal of Nursing Care Quality 16:3, 60-70
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D.C. KNOCKAERT, F. BUNTINX, N. STOENS, R. BRUYNINCKX, H. DELOOZ. (2002) Chest pain in the emergency department: the broad spectrum of causes. European Journal of Emergency Medicine 9:1, 25-30
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Sharon-Lise T. Normand, Kelly H. Zou. (2002) Sample size considerations in observational health care quality studies. Statistics in Medicine 21:3, 331-345
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Adrian R Levy, Robyn M Tamblyn, Peter J Mcleod, David Fitchett, Michal Abrahamowicz. (2002) The Effect of Physicians' Training on Prescribing β-Blockers for Secondary Prevention of Myocardial Infarction in the Elderly. Annals of Epidemiology 12:2, 86-89
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Bruce E. Landon, Ira B. Wilson, Neil S. Wenger, Susan E. Cohn, Carl J. Fichtenbaum, Samuel A. Bozzette, Martin F. Shapiro, Paul D. Cleary. (2002) Specialty Training and Specialization Among Physicians Who Treat HIV/AIDS in the United States. Journal of General Internal Medicine 17:1, 12-22
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John E. Calfee. (2002) The Role of Marketing in Pharmaceutical Research and Development. PharmacoEconomics 20:Supplement 3, 77-85
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McNeil, Barbara J., . (2001) Hidden Barriers to Improvement in the Quality of Care. New England Journal of Medicine 345:22, 1612-1620
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A. Di Carlo, R. H. I. Andtbacka, I. Shrier, P. Belliveau, J. L. Trudel, B. L. Stein, P. H. Gordon, C. A. Vasilevsky. (2001) The value of specialization—is there an outcome difference in the management of fistulas complicating diverticulitis. Diseases of the Colon & Rectum 44:10, 1456-1463
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Douglas P Zipes. (2001) President’s page: the importance of the cardiologist. Journal of the American College of Cardiology 38:3, 918-920
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Rajendra H Mehta, Saif S Rathore, Martha J Radford, Yongfei Wang, Yun Wang, Harlan M Krumholz. (2001) Acute myocardial infarction in the elderly: differences by age. Journal of the American College of Cardiology 38:3, 736-741
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Francisco Gimenez‐Sanchez, Jay C. Butler, Daniel B. Jernigan, Larry J. Strausbaugh, Catherine C. Slemp, Mindy J. Perilla, Scott F. Dowell. (2001) Treating Cardiovascular Disease with Antimicrobial Agents: A Survey of Knowledge, Attitudes, and Practices among Physicians in the United States. Clinical Infectious Diseases 33:2, 171-176
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Barbara J. Turner, Christine Laine. (2001) Differences Between Generalists and Specialists: Knowledge, Realism, or Primum Non Nocere?. Journal of General Internal Medicine 16:6, 422-424
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Valerie E. Stone, Fadi F. Mansourati, Roy M. Poses, Kenneth H. Mayer. (2001) Relation of Physician Specialty and HIV/AIDS Experience to Choice of Guideline-Recommended Antiretroviral Therapy*. Journal of General Internal Medicine 16:6, 360-368
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Sumit R. Majumdar, Thomas S. Inui, Jerry H. Gurwitz, Matthew W. Gillman, Thomas J. McLaughlin, Stephen B. Soumerai. (2001) Influence of Physician Specialty on Adoption and Relinquishment of Calcium Channel Blockers and Other Treatments for Myocardial Infarction. Journal of General Internal Medicine 16:6, 351-359
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Claresa S. Levetan. (2001) The Value of the Clinical Endocrinologist in the New Millennium. The Endocrinologist 11:2, 137-145
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Sandra S. Axtell, Elizabeth Ludwig, A. Lopez-Candales. (2001) Intervention to improve adherence to ACC/AHA recommended adjunctive medications for the management of patients with an acute myocardial infarction. Clinical Cardiology 24:2, 114-118
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Mark Lanzieri, Richard Hobbs, Patricia Roy, Roberta Richmond. (2001) Use of a Clinical Care Map for the Management of Congestive Heart Failure in a Community Hospital. Congestive Heart Failure 7:1, 37-42
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Eric L. Knight, Robert J. Glynn, Raisa Levin, David A. Ganz, Jerry Avorn. (2000) Failure of Evidence-based Medicine in the Treatment of Hypertension in Older Patients. Journal of General Internal Medicine 15:10, 702-709
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Francesca C. Dwamena, Hassan El-Tamimi, Ralph E. Watson, Jill Kroll, Annette Mclane, Margaret Holmes-Rovner, Barbara Mcintosh, Joel Kupersmith, Aryeh D. Stein, . (2000) The use of angiotensin-converting enzyme inhibitors in patients with acute myocardial infarction in community hospitals. Clinical Cardiology 23:5, 341-346
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David Siegel. (2000) The influence of national guidelines on antihypertensive prescribing patterns. Current Hypertension Reports 2:3, 247-252
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Robert B McLafferty, Gary L Dunnington, Mark A Mattos, Stephen J Markwell, Don E Ramsey, John P Henretta, Laura A Karch, Kim J Hodgson, David S Sumner. (2000) Factors affecting the diagnosis of peripheral vascular disease before vascular surgery referral. Journal of Vascular Surgery 31:5, 870-879
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Rajendra H. Mehta, Eduardo Bossone, Kim A. Eagle. (2000) Current concepts in secondary prevention after acute myocardial infarction. Herz 25:1, 47-60
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Lawton R Burns, Douglas R Wholey. 2000. Responding to a consolidating healthcare system: Options for physician organizations. , 273-335.
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Robert H. Fletcher. (1999) The Fairness and Effectiveness of Stroke Care in Health Maintenance Organizations. Medical Care 37:12, 1183-1185
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Jonathan D Trobe, Pamela C Sieving, Kenneth E Guire, A.Mark Fendrick. (1999) The impact of the optic neuritis treatment trial on the practices of ophthalmologists and neurologists. Ophthalmology 106:11, 2047-2053
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Patricia McGettigan, Ketrina Sly, Dianne O'connell, Suzanne Hill, David Henry. (1999) The Effects of Information Framing on the Practices of Physicians. Journal of General Internal Medicine 14:10, 633-642
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Leslie R. Harrold, Terry S. Field, Jerry H. Gurwitz. (1999) Knowledge, Patterns of Care, and Outcomes of Care for Generalists and Specialists. Journal of General Internal Medicine 14:8, 499-511
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Eve A. Kerr, Ron D. Hays, Allison Mitchinson, Martin Lee, Albert L. Siu. (1999) The Influence of Gatekeeping and Utilization Review on Patient Satisfaction. Journal of General Internal Medicine 14:5, 287-296
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Onyekachi Ifudu, Mohammed Dawood, Yakov Iofel, Jean S. Valcourt, Eli A. Friedman. (1999) Delayed referral of black, Hispanic, and older patients with chronic renal failure. American Journal of Kidney Diseases 33:4, 728-733
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Carolyn M. Clancy, Gregg S. Meyer. (1999) Old Questions, New Audiences. Medical Care 37:4, 329-332
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Danny McCormick, Jerry H. Gurwitz, Judith Savageau, Jorge Yarzebski, Joel M. Gore, Robert J. Goldberg. (1999) Differences in Discharge Medication After Acute Myocardial Infarction in Patients with HMO and Fee-for-Service Medical Insurance. Journal of General Internal Medicine 14:2, 73-81
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Harold L. Kennedy. (1999) The importance of randomized clinical trials and evidence-based medicine: A clinician's perspective. Clinical Cardiology 22:1, 6-12
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George W. Kaplan. (1999) RE. The Journal of Urology232
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George W. Kaplan. (1999) RE: SUBSPECIALIZATION, RECRUITMENT AND RETIREMENT TRENDS OF AMERICAN UROLOGISTS. The Journal of Urology 161:1, 232
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(1998) Assessing the Appropriateness of Medical Care. New England Journal of Medicine 339:20, 1478-1481
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Randall S Stafford, David Blumenthal. (1998) Specialty differences in cardiovascular disease prevention practices. Journal of the American College of Cardiology 32:5, 1238-1243
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Paul N Casale, Jayne L Jones, Flossie E Wolf, Yanfen Pei, L.Marlin Eby. (1998) Patients treated by cardiologists have a lower in-hospital mortality for acute myocardial infarction. Journal of the American College of Cardiology 32:4, 885-889
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Richard Adelson, Wendy J. Vanloy, Kenneth Hepburn. (1998) Performance change in an organizational setting: A conceptual model. Journal of Continuing Education in the Health Professions 17:2, 69-80
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Jeff Whittle, Chyongchiou Jeng Lin, Judith R. Lave, Michael J. Fine, Kristin M. Delaney, Dorothy Z. Joyce, Wanda W. Young, Wishwa N. Kapoor. (1998) Relationship of Provider Characteristics To Outcomes, Process, And Costs of Care for Community-Acquired Pneumonia. Medical Care 36:7, 977-987
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Barbara S. Levine, Margaret L. Hall. (1998) Management of Chronic Heart Failure in the Outpatient. AACN Clinical Issues: Advanced Practice in Acute and Critical Care 9:2, 257-267
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Edward H. Yelin, Carol L. Such, Lindsey A. Criswell, Wallace V. Epstein. (1998) Outcomes for Persons With Rheumatoid Arthritis With a Rheumatologist Versus a Non-Rheumatologist as the Main Physician for This Condition. Medical Care 36:4, 513-522
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Harlan M. Krumholz, Daniel M. Philbin, Yun Wang, Viola Vaccarino, Jaime E. Murillo, Michael L. Therrien, Jeanne Williams, Martha J. Radford. (1998) Trends in the Quality of Care for Medicare Beneficiaries Admitted to the Hospital With Unstable Angina. Journal of the American College of Cardiology 31:5, 957-963
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Robert L. Vogel, Richard J. Ackermann. (1998) Is Primary Care Physician Supply Correlated with Health Outcomes?. International Journal of Health Services 28:1, 183-196
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Dennis E. Weiland. (1997) Why use clinical pathways rather than practice guidelines?. The American Journal of Surgery 174:6, 592-595
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Michael L. Green, Peter J. Ellis. (1997) Impact of an Evidence-Based Medicine Curriculum Based on Adult Learning Theory. Journal of General Internal Medicine 12:12, 742-750
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John A. Benson. (1997) The Nephrologist as a primary Care Provider: Foreword. Seminars in Dialysis 10:6, 297-299
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Marshall H. Chin, Peter D. Friedmann, Christine K. Cassel, Roberto M. Lang. (1997) Differences in Generalist and Specialist Physicians' Knowledge and Use of Angiotensin-Converting Enzyme Inhibitors for Congestive Heart Failure. Journal of General Internal Medicine 12:9, 523-530
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Martin E Edep, Nihir B Shah, Ida M Tateo, Barry M Massie. (1997) Differences Between Primary Care Physicians and Cardiologists in Management of Congestive Heart Failure: Relation to Practice Guidelines. Journal of the American College of Cardiology 30:2, 518-526
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Steven E Reis, Richard Holubkov, Daniel Edmundowicz, Dennis M McNamara, Kathleen A Zell, Katherine M Detre, Arthur M Feldman. (1997) Treatment of Patients Admitted to the Hospital With Congestive Heart Failure: Specialty-Related Disparities in Practice Patterns and Outcomes. Journal of the American College of Cardiology 30:3, 733-738
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Jeffrey N. Katz, Daniel H. Solomon, David W. Bates. (1997) Differences between generalists and specialists. Arthritis Care & Research 10:3, 161-162
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Roy M. Poses, Donna K. McClish, Wally R. Smith, D. Mark Chaput de Saintonge, Elizabeth C. Huber, F. Lynne W. Clemo, Brian P. Schmitt, Donna Alexander-Forti, Edward M. Racht, Christopher C. Colenda, Robert M. Centor. (1997) Physicians' Judgments of the Risks of Cardiac Procedures. Medical Care 35:6, 603-617
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(1997) Quality in HIV/AIDS Care Specialty-Related or Experience-Related?. Journal of General Internal Medicine 12:3, 195-197
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Isaac Z. Glatstein, Bernard L. Harlow, Mark D. Hornstein. (1997) Practice patterns among reproductive endocrinologists: the infertility evaluation. Fertility and Sterility 67:3, 443-451
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Ira S Nash, David B Nash, Valentin Fuster. (1997) Do Cardiologists Do It Better?. Journal of the American College of Cardiology 29:3, 475-478
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David E. Wennberg, John D. Dickens, Ab, Lois Biener, Floyd J. Fowler, David N. Soule, Ab, Robert B. Keller. (1997) Do Physicians Do What They Say? The Inclination to Test and Its Association with Coronary Angiography Rates. Journal of General Internal Medicine 12:3, 172-176
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Jollis, James G., DeLong, Elizabeth R., Peterson, Eric D., Muhlbaier, Lawrence H., Fortin, Donald F., Califf, Robert M., Mark, Daniel B., . (1996) Outcome of Acute Myocardial Infarction According to the Specialty of the Admitting Physician. New England Journal of Medicine 335:25, 1880-1887
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Goldman, Lee, . (1996) The Value of Cardiology. New England Journal of Medicine 335:25, 1918-1919
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RICHARD A. HIRTH, A. MARK FENDRICK, MICHAEL E. CHERNEW. (1996) Specialist and Generalist Physicians' Adoption of Antibiotic Therapy to Eradicate Helicobacter pylori Infection. Medical Care 34:12, 1199-1204
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Committee Members, Thomas J. Ryan, Jeffrey L. Anderson, Elliott M. Antman, Blaine A. Braniff, Neil H. Brooks, Robert M. Califf, L. David Hillis, Loren F. Hiratzka, Elliott Rapaport, Barbara J. Riegel, Richard O. Russell, Earl E. Smith, W. Douglas Weaver, James L. Ritchie, Melvin D. Cheitlin, Kim A. Eagle, Timothy J. Gardner, Arthur Garson, Raymond J. Gibbons, Richard P. Lewis, Robert A. O'Rourke, Thomas J. Ryan. (1996) ACC/AHA guidelines for the management of patients with acute myocardial infarction. Journal of the American College of Cardiology 28:5, 1328-1419
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Elsa T. Goldstein. (1996) Outcomes of anorectal disease in a health maintenance organization setting. Diseases of the Colon & Rectum 39:11, 1193-1198
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(1996) Aspirin and Coronary Disease. New England Journal of Medicine 335:15, 1161-1162
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Richard P. Lewis. (1996) President's page: Who is responsible for the cardiovascular patient?. Journal of the American College of Cardiology 28:3, 796-797
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Russell S. Phillips, Mary Beth Hamel, Joan M. Teno, Paul Bellamy, Steven K. Broste, Robert M. Califf, Humberto Vidaillet, Roger B. Davis, Lawrence H. Muhlbaier, Alfred F. Connors, Joanne Lynn, Lee Goldman, . (1996) Race, resource use, and survival in seriously III hospitalized adults. Journal of General Internal Medicine 11:7, 387-396
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C. J. McKenna, M. B. Codd, H. A. McCann, D. D. Sugrue. (1996) International trials and national practice: A questionnaire survey of current physician practice in the treatment of acute myocardial infarction. Irish Journal of Medical Science 165:3, 157-158
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Jerome Yankowitz, Donald M. Howser, John W. Ely. (1996) Differences in practice patterns between obstetricians and family physicians: Use of serum screening. American Journal of Obstetrics and Gynecology 174:4, 1361-1365
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Thomas G. Di Salvo, Sumita D. Paul, Donald Lloyd-Jones, A.J. Conrad Smith, Geraldo Villarreal-Levy, Vitasta Bamezai, Syed Iftikhas Hussain, Kim A. Eagle, Patrick T. O'Gara. (1996) Care of acute myocardial infarction by nonivasive and invasive cardiologist: Procedure use, cost and outcome. Journal of the American College of Cardiology 27:2, 262-269
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J. Braithwaite, J. Westbrook, L. Lazarus. (1995) What will be the outcome of the outcomes movement?. Australian and New Zealand Journal of Medicine 25:6, 731-735
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Donald A. Brand, Lee N. Newcomer, Anne Freiburger, Hao Tian. (1995) Cardiologists' practices compared with practice guidelines: Use of beta-blockade after acute myocardial infarction. Journal of the American College of Cardiology 26:6, 1432-1436
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Steven J. Borowsky, Richard L. Kravitz, Marianne Laouri, Barbara Leaks, Jennifer Partridge, Vidya Kaushik, L. Julian Haywood, Robert H. Brook. (1995) Effect of physician specialty on use of necessary coronary angiography. Journal of the American College of Cardiology 26:6, 1484-1491
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Thomas H. Lee. (1995) How do cardiologists fit in managed care?. Journal of the American College of Cardiology 26:6, 1492-1493
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Sidney Goldstein. (1995) Stabilizing the care of unstable angina. Journal of the American College of Cardiology 26:3, 583-584
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G Grollier, P Scanu, B Valette, D Agostini, J.C. Potier. (1995) Infarctus du myocarde et revascularisation. Indications actuelles. La Revue de Médecine Interne 16:9, 673-683
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Guadagnoli, Edward, Hauptman, Paul J., Ayanian, John Z., Pashos, Chris L., McNeil, Barbara J., Cleary, Paul D., . (1995) Variation in the Use of Cardiac Procedures after Acute Myocardial Infarction. New England Journal of Medicine 333:9, 573-578
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Pilote, Louise, Califf, Robert M., Sapp, Shelly, Miller, Dave P., Mark, Daniel B., Weaver, W. Douglas, Gore, Joel M., Armstrong, Paul W., Ohman, E. Magnus, Topol, Eric J., . (1995) Regional Variation across the United States in the Management of Acute Myocardial Infarction. New England Journal of Medicine 333:9, 565-572
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Desmond G. Julian. (1995) Treatment for survivors of acute myocardial infarction: What have we learned from large intervention trials?. Cardiovascular Drugs and Therapy 9:S3, 495-502
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