Related Experiment Videos
A Canadian comparison of data sources for coronary artery bypass surgery outcome "report cards"
W A Ghali1, D M Rothwell, H Quan
1Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. wghali@ucalgary.ca
Insights
Comparing coronary artery bypass graft (CABG) surgery report cards in Ontario, Canada, found general similarities between administrative and clinical data. However, clinical data are essential for public scrutiny of individual hospital outcomes.
Area of Science:
- Health Services Research
- Cardiovascular Surgery Outcomes Analysis
Background:
- Previous studies on administrative vs. clinical data for coronary artery bypass graft (CABG) surgery report cards, primarily from the US, have yielded conflicting validity conclusions.
- This study addresses this gap by comparing two CABG surgery outcome report cards from Ontario, Canada: one using clinical data (Cardiac Care Network of Ontario) and one using administrative data (Canadian Institute for Health Information).
Purpose of the Study:
- To compare the validity and consistency of administrative versus clinical data sources for generating coronary artery bypass graft (CABG) surgery outcome report cards in Ontario, Canada.
- To assess the correlation and agreement between risk-adjusted mortality rates and hospital rankings derived from distinct data sources.
Main Methods:
- Utilized data from four fiscal years (1992-93 to 1995-96) for 9 hospitals performing CABG surgery in Ontario.
- Employed logistic regression models to calculate risk-adjusted death rates, incorporating clinical variables (e.g., left ventricular ejection fraction) and administrative data for comorbidities and in-hospital mortality.
- Linked Cardiac Care Network clinical data with Canadian Institute for Health Information administrative data.
Main Results:
- Risk-adjusted death rates showed substantial similarity between the two data sources for 7 out of 9 hospitals.
- Absolute differences in adjusted death rates of 0.58% and 0.64% were observed for two hospitals.
- A strong positive correlation was found for both risk-adjusted hospital death rates (intraclass correlation coefficient = 0.927) and rankings (Spearman correlation coefficient = 0.828).
Conclusions:
- Outcome report cards for CABG surgery in Ontario demonstrate general comparability between administrative and clinical data sources.
- Despite similarities, clinical data remain crucial for detailed public scrutiny of individual hospital performance in outcome reporting.
Background:
Prior comparisons of administrative versus clinical data for creating coronary artery bypass graft (CABG) surgery outcome "report cards" are all from the United States and yield inconsistent conclusions regarding the validity of administrative data report cards. In this study, we compared 2 CABG surgery outcome report cards for Ontario, Canada: one derived from clinical data from the Cardiac Care Network of Ontario and one derived from administrative data from the Canadian Institute for Health Information.
Methods:
Data from 4 fiscal years, 1992-93 through 1995-96, were used. The Canadian Institute for Health Information report card was derived from administrative data only. The Cardiac Care Network report card drew on prospectively collected clinical information that included variables such as left ventricular ejection fraction but also required linkages to the Canadian Institute for Health Information data for ascertainment of selected comorbidities and in-hospital mortality rates. Logistic regression models were used to calculate risk-adjusted death rates for each of the 9 hospitals performing CABG surgery in Ontario.
Results:
The risk-adjusted death rates were quite similar between data sources for 7 of the 9 hospitals. For 2 hospitals, rather large absolute differences in adjusted death rates of 0.58% and 0.64% were seen between report cards. There was a strong correlation between data sources for risk-adjusted hospital death rates (intraclass correlation coefficient = 0.927, P <.001) and for rankings of adjusted hospital death rates (Spearman correlation coefficient = 0.828, P =.02).
Conclusion:
These results from Ontario, Canada, reveal general similarities between administrative and clinical data report cards for CABG surgery. However, clinical data are likely needed if individual hospitals are to be publicly scrutinized in outcome report cards.