California Hospital CABG Mortality Reporting Program

Problem: A considerable number of hospitals performing Coronary Artery Bypass Graft (CABG) surgery in California do so few (i.e., fewer than 200 cases annually) that there is significant concern that they do not have sufficient volume to produce consistently good outcomes. Wide variations exist among hospitals in death rates for patients undergoing bypass surgery, but little individual hospital information has historically been available for use by consumers and clinicians. Currently, there is not a standardized system to collect and publicly report comparative outcomes data for most key surgical procedures, save bypass surgery. Patients who need to have bypass surgery and their referring physicians need comparative hospital performance data to make better decisions. Comparative hospital scores also provide critical information to enable hospitals to identify and remedy quality of care problems.

PBGH Role and Project Description: PBGH served as a catalyst for public accountability on the quality of bypass surgery and for other procedures. The California CABG Mortality Reporting Program was a voluntary effort established in 1996 to measure and report hospital-specific, in-hospital death rates for bypass surgery. The first of three reports from this voluntary effort was released in August 2001 and included data from 79 of the 118 California hospitals that perform bypass surgery for 1997-1998. These hospitals performed over 70 percent of all the bypass surgeries done in California annually. Rates of individual hospitals are risk-adjusted to account for differences in the sickness of patients at each hospital. This makes the comparisons fair and doesn't create incentives to avoid treating sicker patients. The program was originally a joint venture of the Office of Statewide Health Planning and Development (OSHPD) and PBGH. The PBGH Quality Improvement Fund and OSHPD underwrote the effort.

The PBGH-OSHPD voluntary program served as the impetus for making the reporting mandatory in California. Legislation enacted in October 2001 (SB 680) mandates OSHPD to report on hospital Coronary Artery Bypass Graft (CABG) outcomes annually for all hospitals performing the procedure and to produce a surgeon-level CABG report every other year. The second mandatory report was the first detailing results for all 302 responsible surgeons who performed CABG surgeries in 2003-2004. The third mandatory report was released in 2008 containing results from the 2005 reporting year.

Impact: CABG surgery is one of the most frequently performed surgeries. When the voluntary reporting project was initiated, approximately 27,000 Californians with advanced heart disease underwent CABG surgery. While fewer CABG surgeries are now performed as angioplasties have increased, CABG surgery remains among the top ten surgeries performed in California. Public reporting of mortality ratings encourages hospitals to focus on quality improvement, recognizes hospitals that achieve excellent patient outcomes, fosters a culture of openness about outcomes in health care and raises consumer and purchaser awareness of quality differences among facilities. Thanks in part to this voluntary initiative, legislated mandatory reporting of mortality rates for all hospitals, and surgeon-specific rates are available to assist consumer decision-making.

Since the inception of the CABG Mortality Reporting Program, an expanded voluntary quality reporting program was established through the California Hospital Assessment and Reporting Taskforce (CHART). Measures include Heart Attack, Heart Failure, Pneumonia Care, Coronary Artery Bypass, Maternity Care, Critical Care, Patient Safety and Patient Experience Surveys.

Current Activities: The new CABG report, focusing on 2005 performance results, is the third "mandatory participation" report resulting from SB 680. The report details quality ratings for all 120 California hospitals that performed CABG surgeries in 2005 and shows that 114 hospitals performed as expected, three hospitals performed better than expected and three hospitals performed worse than expected. The overall statewide mortality rate was 3.08 percent in 2005 compared to 3.29 percent in 2004. These data are incorporated into the CHART reporting program. PBGH also represents the purchaser voice on the CHART Board of Directors and as co-Chair of the New Measures Advisory Group.

Use the following links to learn more about the most recently released California Report on CABG Surgery.

• The 2007 California Report on Coronary Artery Bypass Graft Surgery full report.
• View data on surgeon-level results.
• Read the press release about California's third report on Bypass Surgery issued January, 2008.
• View CHART hospital quality ratings here.
• View CHART Fact Sheet.

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