• AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals - volume, mortality, and utilization [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 91 p.



• AHRQ quality indicators. Inpatient quality indicators: technical specifications [version 3.2]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Feb 29. 37 p.

Does not apply to this measure

This measure is used to assess the number of coronary artery bypass grafts (CABGs) per 100,000 population.

Coronary artery bypass graft (CABG) is performed on patients with coronary artery disease. No ideal rate for CABG has been established. CABG is a potentially overused procedure, although several studies have noted that CABG is not often performed for inappropriate indications (under 15%).

As an area utilization indicator*, CABG is a proxy for actual quality problems. This indicator in particular has unclear construct validity, because CABG does not appear to be performed inappropriately often. Caution should be maintained for CABG rates that are drastically below or above the average or recommended rates.

*The following caveats were identified from the literature review for the "Coronary Artery Bypass Graft Area Rate" indicator:

• Proxy^b: Indicator does not directly measure patient outcomes but an aspect of care that is associated with the outcome; thus, it is best used with other indicators that measure similar aspects of care.
• Unclear construct^b: There is uncertainty or poor correlation with widely accepted process measures.
• Unclear benchmark^b: The "correct rate" has not been established for the indicator; national, regional, or peer group averages may be the best benchmark available.

Refer to the original measure documentation for further details.

Note:

b - Indicates that the concern has been demonstrated in the literature.

Coronary artery disease; coronary artery bypass graft (CABG)

Population in Metro Area or county, age 40 years and older

Number of coronary artery bypass grafts (CABGs) in any procedure field among all discharges age 40 years and older

Exclude cases:

• Major Diagnostic Category (MDC) 14 (pregnancy, childbirth, and puerperium)
• MDC 15 (newborns and other neonates)

Note: Refer to the Technical Specifications document for specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.

• One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Monitoring and planning
Variation in use of service

• AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals - volume, mortality, and utilization [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 91 p.

Current routine use

External oversight/State government program
Monitoring and planning

Hospitals

Physicians
Public Health Professionals

Counties or Cities

Age greater than or equal to 40 years

Either male or female

Unspecified

In a follow-up to a New York appropriateness study, a panel of cardiologists found a rate of inappropriate procedure of 6% and a rate of uncertain procedures of 12%. In another study of 12 hospitals, the rate of coronary artery bypass graft (CABG) for inappropriate indications ranged from 0% to 5% across hospitals, and the rate of CABG for uncertain indications ranged from 5% to 8%.

Unspecified

Unspecified

Unspecified

Unspecified

Not within an IOM Care Need

Not within an IOM Domain

Both users and nonusers of care

Population in Metro Area or county, age 40 years and older

Geographically defined

Inclusions
Population in Metro Area or county, age 40 years and older

Exclusions
Unspecified

All cases in the denominator are not equally eligible to appear in the numerator

Patient Characteristic

Time window is a single point in time

Inclusions
Number of coronary artery bypass grafts (CABGs) in any procedure field among all discharges age 40 years and older

Note: Refer to the Technical Specifications document for specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.

Exclusions
Exclude cases:

• Major Diagnostic Category (MDC) 14 (pregnancy, childbirth, and puerperium)
• MDC 15 (newborns and other neonates)

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Institutionalization

Administrative data

Does not apply to this measure

Unspecified

Rate

Undetermined

Analysis by subgroup (stratification on patient factors, geographic factors, etc.)

Observed (raw) rates may be stratified by areas (Metro Area or counties), age groups, race/ethnicity categories, and sex.

Risk adjustment of the data is recommended using, at minimum, age and sex.

Application of multivariate signal extraction (MSX) to smooth risk adjusted rates is also recommended.

External comparison at a point in time
External comparison of time trends
Internal time comparison

Each potential quality indicator was evaluated against the following six criteria, which were considered essential for determining the reliability and validity of a quality indicator: face validity, precision, minimum bias, construct validity, fosters real quality improvement, and application. The project team searched Medline for articles relating to each of these six areas of evaluation. Additionally, extensive empirical testing of all potential indicators was conducted using the 1995-97 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and Nationwide Inpatient Sample (NIS) to determine precision, bias, and construct validity. Table 2 in the original measure documentation summarizes the results of the literature review and empirical evaluations on the Inpatient Quality Indicators. Refer to the original measure documentation for details.

• AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals - volume, mortality, and utilization [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 91 p.

Coronary artery bypass graft (CABG) area rate (IQI 26).

Agency for Healthcare Research and Quality

Agency for Healthcare Research and Quality (AHRQ)

The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators are in the public domain and the specifications come from multiple sources, including the published and unpublished literature, users, researchers, and other organizations. AHRQ as an agency is responsible for the content of the indicators.

None

The hospital-based rate of CABG was included in the original Healthcare Cost and Utilization Project Quality Indicator (HCUP QI) set.

Coronary Artery Bypass Graft (CABG) (Agency for Healthcare Research and Quality)

2002 Jun

2008 Feb

This is the current release of the measure.

This measure updates previous versions:

• AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals -- volume, mortality, and utilization [version 3.0]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2006 Feb 20. 99 p.
• AHRQ quality indicators. Inpatient quality indicators: technical specifications [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 37 p.

• AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals - volume, mortality, and utilization [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 91 p.



• AHRQ quality indicators. Inpatient quality indicators: technical specifications [version 3.2]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Feb 29. 37 p.

This NQMC summary was completed by ECRI on February 3, 2006. The information was verified by the measure developer on March 6, 2006. This NQMC summary was updated by ECRI Institute on May 29, 2007 and again on October 20, 2008.

No copyright restrictions apply.