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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 serves 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 report 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. The second report, released in September 2003,
covers 1999 and the 1997-1998 period and includes results for 70 of the
119 hospitals performing bypass surgery statewide. The third and final voluntary
report, released in February 2005, reports mortality rates for 77 participating
hospitals in 2000-2002. The 77 hospital participants perform 73 percent
of all the bypass surgeries done in California each year. 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 is 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.
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 PBGH-OSHPD voluntary program served as the impetus for making the reporting mandatory in California. The first mandatory report was released in 2006 containing results from the 2003 reporting year. Impact: CABG surgery is one of the most frequently performed surgeries. Each year, approximately 27,000 Californians with advanced heart disease undergo CABG surgery. The hospitals that participated in this voluntary initiative demonstrated their commitment to health care quality by their willingness to see their outcomes reported publicly. Public reporting of mortality ratings will encourage hospitals to focus on quality improvement, recognize and reward hospitals that achieve excellent patient outcomes, foster a culture of openness about outcomes in health care and raise 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 later surgeon-specific rates will be available to assist consumer decision-making. Current Activities:
The new CABG report, focusing on 2003 performance results, is the first
"mandatory participation" report resulting from SB 680.
The report details quality ratings for all 121 California hospitals that
performed CABG surgeries in 2003 and shows that 113 hospitals performed
as expected, four hospitals performed better than expected and four hospitals
performed worse than expected. The overall statewide mortality rate
was 2.91 percent in 2003. If you need to download Acrobat Reader, click here. Use the following links to learn more about the most recently released California Report on CABG Surgery.
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