For patients requiring coronary artery bypass (CABG) surgery or percutaneous coronary intervention (PCI), the likelihood of choosing a better than average hospital depends significantly on the state where that hospital is located. According to new research conducted by Cardiac Data Solutions, patients randomly choosing a hospital in one of the 10 best states had a 1 in 3 chance of picking a hospital with better than average performance for both CABG and PCI. On the other hand, patients in four of the 10 worst states had no chance of going to a hospital that was better than average for both procedures.
The research, which evaluated data on nearly 320,000 Medicare beneficiaries undergoing either CABG or PCI in more than 700 US hospitals from October 1, 2009 to September 30, 2010, was presented at American Heart Association Quality of Care and Outcomes Research 2012 Scientific Sessions.
"When states report hospital mortality rates for cardiovascular procedures, very few hospitals are typically said to perform better or worse than the average US hospital," stated April Simon, RN, MSN, one of the researchers and president of Cardiac Data Solutions. "Our results, on the other hand, show a significant difference when you consider revascularization (PCI and CABG) outcomes in total. Because these results are risk adjusted, they take into account how sick patients are upon admission. We plan to conduct additional research to understand if specific state or hospital initiatives are driving the results and whether public reporting of outcomes and/or more innovative cardiovascular medical communities make a difference."
Only two states, Massachusetts and Maryland, had all of their hospitals rank above average for both procedures. Hospitals in 7 of the top 10 ranked states saved more lives performing PCI than CABG. In contrast, hospitals in 6 of the 10 worst performing states lost more lives performing PCI than CABG surgery. A total of 4 states (Hawaii, North Dakota, Nevada and Oklahoma) had all of their hospitals rank below average for both procedures.
Other researchers included: Aaron D. Kuglemass, MD, Baystate Health; Phillip P. Brown, MD, Cardiac Data Solutions; Matthew R. Reynolds, MD, Harvard Clinical Research Institute; David J. Cohen, MD, St. Luke's Mid-America Heart Institute; and Steven D. Culler, PhD, Rollins School of Public Health, Emory University.