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E. Hannan, H. Kilburn, J. O'donnell, G. Lukacik, E. Shields (1990)
Adult open heart surgery in New York State. An analysis of risk factors and hospital mortality rates.JAMA, 264 21
E. Hannan, H. Kilburn, J. O'donnell, G. Lukacik, E. Shields (1991)
Interracial Access to Selected Cardiac Procedures for Patients Hospitalized with Coronary Artery Disease in New York StateMedical Care, 29
L. Campeau (1976)
Letter: Grading of angina pectoris.Circulation, 54 3
G. O'connor, S. Plume, E. Olmstead, L. Coffin, J. Morton, C. Maloney, E. Nowicki, J. Tryzelaar, F. Hernandez, L. Adrian, Kevin Casey, D. Soule, C. Marrin, W. Nugent, D. Charlesworth, Robert Clough, S. Katz, B. Leavitt, J. Wennberg (1991)
A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting. The Northern New England Cardiovascular Disease Study Group.JAMA, 266 6
E. Hannan, J. O'donnell, H. Kilburn, H. Bernard, A. Yazici (1989)
Investigation of the Relationship Between Volume and Mortality for Surgical Procedures Performed in New York State HospitalsJAMA, 262
D. Berwick (1989)
Continuous improvement as an ideal in health care.The New England journal of medicine, 320 1
G. Laffel, D. Blumenthal (1989)
The case for using industrial quality management science in health care organizations.JAMA, 262 20
E. Hannan, H. Kilburn, Michael Lindsey, R. Lewis (1992)
Clinical Versus Administrative Data Bases for CABG Surgery: Does it MatterMedical Care, 30
E. Hannan, H. Kilburn, Harvey Bernard, J. O'donnell, G. Lukacik, E. Shields (1991)
Coronary Artery Bypass Surgery: The Relationship Between Inhospital Mortality Rate and Surgical Volume After Controlling For Clinical Risk FactorsMedical Care, 29
D. Hosmer, S. Lemeshow (1991)
Applied Logistic Regression
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. (JAMA. 1994;271:761-766)
JAMA – American Medical Association
Published: Mar 9, 1994
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