About 30% of personal health care expenditures in the United States go towards hospital care, and the rate of growth in spending for hospital services has only recently leveled out after several years of increases following a half a decade of declining growth. Simultaneously, concerns about the quality of health care services have reached a crescendo with the Institute of Medicine's series of reports describing the problem of medical errors and the need for a complete restructuring of the health care system to improve the quality of care. Policymakers, employers, and consumers have made the quality of care in U.S. hospitals a top priority and have voiced the need to assess, monitor, track, and improve the quality of inpatient care.
Coronary artery bypass graft (CABG) is a relatively common procedure that requires proficiency with the use of complex equipment; and technical errors may lead to clinically significant complications, such as myocardial infarction, stroke, and death. Better processes of care may reduce mortality for CABG, which represents better quality care.
CABG mortality is one of the most widely used and publicized post-procedural mortality indicators. Demographics, comorbidities, and clinical characteristics of severity of disease are important predictors of outcome that may vary systematically by provider. Chart review may help distinguish comorbidities from complications.
Note:
The following caveats were identified from the literature review for the "Coronary Artery Bypass Graft Mortality Rate" indicator:
- Selection biasa: This results when a substantial percentage of care for a condition is provided in the outpatient setting, so the subset of inpatient cases may be unrepresentative. Examination of outpatient care or emergency care data may help to reduce this in these cases.
- Confounding biasb: Patient characteristics may substantially affect the performance of the indicator; risk adjustment is recommended.
- Unclear constructa: There is uncertainty or poor correlation with widely accepted process measures.
- Easily manipulateda: Use of the indicator may create perverse incentives to improve performance on the indicator without truly improving quality of care.
Refer to the original measure documentation for further details.
a - The concern is theoretical or suggested, but no specific evidence was found in the literature.
b - Indicates that the concern has been demonstrated in the literature.
