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Using Medicare claims data to assess provider quality for CABG surgery: does it work well enough?
E L Hannan1, M J Racz, J G Jollis
1Department of Health Policy and Management, School of Public Health, State University of New York at Albany 1244-3456, USA.
Health Services Research
|February 1, 1997
Summary
Clinical data significantly improves mortality prediction for coronary artery bypass grafting (CABG) surgery patients. Combining clinical and administrative data offers more accurate hospital quality assessments than administrative data alone.
Area of Science:
- Health Services Research
- Outcomes Research
- Cardiovascular Surgery
Background:
- Assessing hospital quality of care is crucial for patient outcomes.
- Coronary Artery Bypass Grafting (CABG) surgery outcomes are complex and influenced by various factors.
- Existing administrative datasets may have limitations in accurately capturing patient complexity and care quality.
Purpose of the Study:
- To compare the predictive accuracy of clinical versus administrative data for CABG surgery mortality.
- To evaluate the ability of both data types to assess hospital quality of care.
- To identify optimal data strategies for outcomes research in cardiovascular surgery.
Main Methods:
- Utilized 1991-1992 data from New York's Cardiac Surgery Reporting System (clinical) and HCFA's MEDPAR (administrative).
- Conducted an observational study on 13,577 isolated CABG surgery patients across 31 New York State hospitals.
- Employed risk-adjusted mortality rates, outlier identification, and statistical model discrimination/calibration as outcome measures.
Main Results:
- Administrative models overestimated discriminatory power due to miscoded complications as comorbidities.
- Distinguishing complications from comorbidities significantly altered provider performance assessments.
- Incorporating limited clinical data elements substantially improved administrative model fit.
- Clinical models using all CABG patients identified more outlier hospitals than Medicare-only models.
Conclusions:
- Administrative data require careful handling to distinguish complications from comorbidities for accurate outcomes research.
- Appending limited clinical data to administrative datasets enhances the accuracy of outcomes assessment.
- Medicare data alone may not represent the full spectrum of CABG surgery patient outcomes, potentially leading to misleading quality assessments.