Each year, more than 27,000 Californians are admitted to the hospital for bypass surgery to restore blood flow through their coronary arteries. Yet few of these patients know how their hospital measures up as far as surgical outcomes.
Last week, a state agency and a private coalition of 45 California employers that buy health insurance jointly released the first public accounting of death rates after heart bypass surgery.
The initial report from the California Coronary Artery Bypass Graft Mortality Reporting Program is intended to help hospitals, surgeons, policymakers, insurers and consumers compare how well hospitals are getting patients through the sophisticated and sometimes life-saving operation.
The report, covering 1997 and 1998, is a first step in holding California hospitals accountable, making the surgery safer and helping consumers make better-informed decisions about the procedure.
FOR THE RECORD
Los Angeles Times Wednesday August 8, 2001 Home Edition Part A Part A Page 2 A2 Desk 3 inches; 79 words Type of Material: Correction
Heart bypass chart--A chart in Monday's Health section about coronary bypass death rates for 1997 and 1998 at California hospitals may have been misleading. The chart should have stated that Hoag Memorial Hospital Presbyterian in Newport Beach was rated "better than expected" because it had fewer deaths than would have been predicted, given how sick its patients were. Downey Community Hospital in Downey and Presbyterian Intercommunity Hospital in Whittier should have been rated "worse than expected" because their death rates were higher than predicted.
For the Record
Los Angeles Times Monday August 13, 2001 Home Edition Health Part S Page 3 View Desk 3 inches; 80 words Type of Material: Correction
Heart bypass chart--A chart in last Monday's Health section about coronary bypass death rates for 1997 and 1998 at California hospitals may have been misleading. The chart should have shown that Hoag Memorial Hospital Presbyterian in Newport Beach was rated "better than expected" because it had fewer deaths than would have been predicted given how sick its patients were. Downey Community Hospital in Downey and Presbyterian Intercommunity Hospital in Whittier should have been rated "worse than expected" because their death rates were higher than predicted.
"The benefit will be that hospitals and surgeons and other caregivers will be able to look at their performance in a very objective way and ... embark on a quality improvement program," said Dr. Daniel Ullyot, director of cardio-thoracic surgery at Mills-Peninsula Medical Center in Burlingame.
The report on patient deaths after surgery is based on information about 30,814 bypasses collected from 79 hospitals that agreed to participate in the study. Those hospitals--among 118 that offer the procedure--accounted for 70% of the bypasses performed in California in 1997 and 1998. The data showed 802 deaths among patients who received grafts in their coronary arteries--a mortality rate of 2.6%.
"We're doing well in California," said Dr. David M. Carlisle, director of the Office of Statewide Health Planning and Development, which prepared the report with the Pacific Business Group on Health, a San Francisco-based alliance of major employers who jointly purchase health insurance for their workers.
But "there's room for improvement statewide," said Cheryl Damberg, director of research for the alliance.
The report concluded that 72 of the 79 hospitals performed "as expected" on coronary bypass procedures. That meant that when hospital mortality rates were statistically adjusted to reflect the severity of the patients' illness, the number of deaths fell within an expected range. Put another way, the study took into account that hospitals, that tend to treat a higher number of very sick patients who would be at greater risk of death, could not be compared directly with hospitals that treat less severely ill patients.
While the vast majority of the hospitals were given the "as expected" rating, there were subtle variations in the data that could influence health insurers' decisions on which doctors and hospitals to contract with for cardiac services. It also could influence medical groups' decisions about which hospitals to send patients for bypass procedures.
Four hospitals statewide performed significantly worse than expected, including two in Southern California: Downey Community Hospital in Downey and Presbyterian Intercommunity Hospital in Whittier.
Dr. Bill Kim, Downey Community's medical director, questioned the study's methodology. He said that in 2000--a year not included in the study--the hospital's death rate for bypass surgeries "was well below the national average." Dr. J.R. Hamilton, vice president of medical affairs at Presbyterian Intercommunity, said the hospital's mortality rates have improved each of the last three years.
Hoag Memorial Presbyterian Hospital in Newport Beach was among three hospitals that did significantly better than expected.
Differences in mortality rates reflect variations in preoperative care, surgical practices, the skill of surgeons and nurses and care after the operation.
The American College of Cardiology recommended a decade ago that a hospital should perform at least 200 to 300 bypasses a year to assure good results. But 68 California hospitals performed fewer than 200 in 1998, the report said. That, Damberg suggested, should send up a red flag to patients who have a choice of hospitals. The report can help them seek out hospitals that do more bypasses or find the lower-volume hospitals that get excellent results.
With the report, the first in a planned series, California joins New York, Pennsylvania and New Jersey in releasing data on bypass surgery.
Several major California hospitals, including Huntington Memorial in Pasadena and Harbor-UCLA in Torrance, declined to submit bypass results.
Some hospitals that declined to participate questioned the study's statistical methods or complained that they lacked the staff or technology to collect the information, Damberg said.
Dr. Joseph S. Carey of Torrance said that there was "a lot of suspicion among physicians about public release of data," because they believed consumers would not be able to interpret it, and that doctors disliked numerical rankings.