Publishing CABG results may mean better outcomes

New York, California profiling efforts secure results

Since 1989, New York has been collecting and publishing mortality rates and detailed clinical and outcomes data on all hospitals and on individual surgeons who performed coronary artery bypass grafts (CABG) in the state. New York is the first to release such risk-adjusted provider profiling and, though meant to increase consumer awareness, the effort has been controversial.

Mortality rates for bypass surgery appear to have declined in the state, but critics of the program claim that since the profiling effort, New York surgeons now routinely transfer high risk patients to hospitals outside the state in order to maintain a good record. One review stated that substantial numbers of patients had been transferred to the Cleveland Clinic from New York.1

For a new study, a group of physicians examined Medicare data from patients in New York who underwent bypass surgery.2 They confirmed that, since the enactment of New York’s provider profiling, mortality rates dropped significantly and faster than the rest of the nation — 33% vs. 19% — but found no evidence that high risk patients in New York were forced to seek help in other states or access to procedures had declined in high-risk patients since the program’s initiation. They concluded that the provider profiling program is a potential means of improving patient outcomes while maintaining access to care.

California’s CHOP gets high marks

Hospitals need to know what others in the state and elsewhere are doing, says a new survey. The 1996 California Hospital Outcomes Project (CHOP) has been deemed by hospital CEOs to be "somewhat helpful" in improving the quality of care for acute myocardial infarction (AMI) patients.3 The Agency for Health Care Policy and Research in Rockville, MD, surveyed 374 CEOs to see what they thought of the project, which presented 30-day inpatient death rates for AMI patients treated in California.

Three-fourths of leaders surveyed found the report most helpful for benchmarking performance, improving how physicians code patients’ diagnoses, and educating physicians about medical record documentation and clinical pathways. One of the investigators noted that hospitals want to know what others with good outcomes are doing differently so they can improve their practices.

Some hospitals took specific quality improvement actions following release of the CHOP report — they developed or refined AMI pathways, improved use of thrombolytic therapy, or reassigned medical staff to improve AMI outcomes.

References

1. Omoigui NA, Miller DP, Brown KJ, et al. Outmigration for coronary bypass surgery in an era of public dissemination of clinical outcomes. Circulation 1996; 93:27-33.

2. Peterson ED, DeLong E, et al. The effects of New York bypass surgery provider profiling on access to care and patient outcomes in the elderly. J Am Coll Cardiol 1998; 32:993-999.

3. Rainwater JA, Romano PS, Antonius DM. The California hospital outcomes project: How useful is California’s report card for quality improvement? Journal on Quality Improvement 1998; 24:31-39.