AIM: Shop for quality, not hospital volume, for better CABG outcomes
Maximizing adherence to quality measures is associated with improved mortality rates, independent of hospital or surgeon volume for coronary artery bypass surgery (CABG), according to an observational cohort published May 19 in the Annals of Internal Medicine.
Andrew D. Auerbach, MD, from the division of medicine at the University of California, San Francisco, and colleagues sought to determine how volume and differences in quality of care influence outcomes after CABG by evaluating 164 U.S. hospitals.
The researchers evaluated 81,289 patients (18 years or older), who had CABG from Oct. 1, 2003 to Sept. 1, 2005.
Quality measures were defined by whether patients received specific medications and by counting the number of measures missed, the authors wrote. Hierarchical models were used to estimate effects of volume and quality on death and readmission up to 30 days.
After adjustment for clinical factors, Auerbach and colleagues found that the lowest surgeon volume and highest hospital volume were associated with higher mortality rates and lower readmission risk, respectively. Patients who did not receive aspirin (odds ratio, 1.89) or beta-blockers (odds ratio, 1.29) had higher odds for death, after adjustment for clinical risk factors and case volume.
The researchers said that adjustment for individual quality measures did not alter associations between volume and readmission or death. However, if no quality measures were missed, mortality rates at the lowest-volume centers (adjusted mortality rate, 1.05 percent) and highest-volume centers (adjusted mortality rate, 0.98 percent) were similar.
As a limitation to their study, the authors wrote that because administrative data were used, the quality measures may not replicate measures collected through chart abstraction.
Based on their findings, Auerbach and colleagues concluded that consistent performance on measures of quality seems more important than volume of surgery.
California HealthCare Foundation provided the majority of the funding for the study.
Andrew D. Auerbach, MD, from the division of medicine at the University of California, San Francisco, and colleagues sought to determine how volume and differences in quality of care influence outcomes after CABG by evaluating 164 U.S. hospitals.
The researchers evaluated 81,289 patients (18 years or older), who had CABG from Oct. 1, 2003 to Sept. 1, 2005.
Quality measures were defined by whether patients received specific medications and by counting the number of measures missed, the authors wrote. Hierarchical models were used to estimate effects of volume and quality on death and readmission up to 30 days.
After adjustment for clinical factors, Auerbach and colleagues found that the lowest surgeon volume and highest hospital volume were associated with higher mortality rates and lower readmission risk, respectively. Patients who did not receive aspirin (odds ratio, 1.89) or beta-blockers (odds ratio, 1.29) had higher odds for death, after adjustment for clinical risk factors and case volume.
The researchers said that adjustment for individual quality measures did not alter associations between volume and readmission or death. However, if no quality measures were missed, mortality rates at the lowest-volume centers (adjusted mortality rate, 1.05 percent) and highest-volume centers (adjusted mortality rate, 0.98 percent) were similar.
As a limitation to their study, the authors wrote that because administrative data were used, the quality measures may not replicate measures collected through chart abstraction.
Based on their findings, Auerbach and colleagues concluded that consistent performance on measures of quality seems more important than volume of surgery.
California HealthCare Foundation provided the majority of the funding for the study.