Improving the outcomes of coronary artery bypass surgery in New York State.
Improving the outcomes of coronary artery bypass surgery in New York State.
复制标题
DOI：
10.1001/jama.1994.03510340051033
复制
发表时间：
1994-03
期刊：
影响因子：
--
通讯作者：
E. Hannan;H. Kilburn;Michael J. Racz;E. Shields;M. Chassin
中科院分区：
文献类型：
--
作者：
E. Hannan;H. Kilburn;Michael J. Racz;E. Shields;M. Chassin
目的评估自1989年以来纽约冠状动脉旁路移植术（CABG）结果的变化，当时美国卫生部开始收集、分析和传播有关CABG手术风险因素、死亡率和并发症的信息。这些新数据刺激了全州医院的具体质量改进活动。设计一个临床数据库被用来确定重要的独立风险因素，并评估风险调整后的供应商死亡率。研究对象：1989年至1992年期间在纽约进行CABG手术的所有30家医院。所有57，187例接受隔离CABG手术的患者均于1989年至1992年期间从纽约州立医院出院。主要观察指标：实际、预期（从逻辑回归模型）和风险调整后的住院死亡率。结果实际死亡率从1989年的3.52%下降到1992年的2.78%。由于平均患者的疾病严重程度增加，风险调整后的死亡率下降更多-从1989年的4.17%下降到1992年的2.45%，下降了41%。风险调整模型表现良好;在10个患者严重程度水平中的任何一个水平上，实际死亡人数与预测死亡人数之间均无临床或统计学显著差异。结论：我们认为，这项质量改进计划，基于收集和传播的风险调整后的死亡率数据的CABG手术，发挥了显着的作用，从这个程序中观察到的死亡率下降。应根据其他程序和条件的类似原则开展质量改进计划。
OBJECTIVE To assess changes in outcomes of coronary artery bypass graft (CABG) surgery in New York since 1989, when the State Department of Health began collecting, analyzing, and disseminating information regarding risk factors, mortality, and complications of CABG surgery. These new data stimulated specific quality improvement activities at hospitals throughout the state. DESIGN A clinical database was used to identify significant independent risk factors and to assess risk-adjusted provider mortality rates. SETTING All 30 hospitals performing CABG surgery in New York during the period 1989 through 1992. PATIENTS All 57,187 patients undergoing isolated CABG surgery who were discharged from New York State hospitals in 1989 through 1992. MAIN OUTCOME MEASURES Actual, expected (from a logistic regression model), and risk-adjusted in-hospital mortality. RESULTS Actual mortality decreased from 3.52% in 1989 to 2.78% in 1992. Because average patient severity of illness increased, risk-adjusted mortality decreased even more--a decrease of 41% from 4.17% in 1989 to 2.45% in 1992. The risk-adjustment model performed well; there were no clinically or statistically significant differences between actual and predicted numbers of deaths at any of 10 levels of patient severity. CONCLUSIONS We believe that this quality improvement program, based on the collection and dissemination of risk-adjusted mortality data for CABG surgery, played a significant role in the observed decline in the death rate from this procedure. Quality improvement programs based on similar principles for other procedures and conditions should be undertaken.