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Assessment of Coronary Artery Bypass Graft Surgery Performance in New YorkIs There a Bias Against Taking High-Risk Patients?

 

作者: Edward Hannan*,   Albert Siu†,   Dinesh Kumar*,   Michael Racz*,   David Pryor‡,   Mark Chassin†,  

 

期刊: Medical Care  (OVID Available online 1997)
卷期: Volume 35, issue 1  

页码: 49-56

 

ISSN:0025-7079

 

年代: 1997

 

出版商: OVID

 

关键词: hospital report cards;risk-adjusted mortality;high-risk coronary artery bypass graft patients

 

数据来源: OVID

 

摘要:

Objectives.The purpose of this study was to determine whether performing coronary artery bypass surgery on high-risk patients adversely affects the risk-adjusted mortality rates for patients of surgeons and hospitals in New York State compared with the impact of performing surgery on more routine patients.Methods.Risk-adjusted mortality rates were calculated for 31 hospitals and 87 surgeons for high-risk (a predicted mortality rate of at least 7.5%) and low-risk patients during the time period 1990 to 1992.Results.The risk-adjusted mortality for all high-risk patients was lower (2.94%) than the risk-adjusted mortality for other patients (3.02%). Fifteen of the 31 hospitals had a lower risk-adjusted mortality for all patients than they did for low-risk patients only, and no differences in either direction were statistically significant. Forty-one of 87 surgeons (47%) had risk-adjusted mortality for all patients that was at least as low as the risk-adjusted mortality for low-risk patients. In general, hospitals and surgeons with the lowest risk-adjusted mortality for all cases also had the lowest risk-adjusted mortality for high-risk cases.Conclusions.The authors conclude that there is no systematic bias against operating on high-risk coronary artery bypass graft patients in the risk-adjusted performance system in New York.

 



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