The Processes, Structures, and Outcomes of Care in Cardiac Surgery Study Protocol

Shroyer, A. Laurie; Mj, London; Cb, VillaNueva; Gk, Sethi; Marshall, Guillermo; Moritz, Thomas; Wg, Henderson; Mj, McCarthy; Fl, Grover; Ke, Hammermeister

doi:10.1097/00005650-199510001-00003

Cited by 16 publications

(12 citation statements)

References 7 publications

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“…Second, our results may not apply to other risk‐adjustment models. Although the New York model uses most of the same data elements as the VHA (Shroyer et al 1995) and the American Society for Thoracic Surgeons (Jones et al 1996), among others (Block et al 1998), New York State has much more experience with its data collection (in operation since 1989) and has lower overall mortality rates from CABG (Hannan et al 2003). Risk‐adjustment models used by other states may not apply as equally well to veterans.…”

Section: Discussionmentioning

confidence: 99%

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New York's Statistical Model Accurately Predicts Mortality Risk for Veterans Who Obtain Private Sector CABG

Weeks

Bazos²,

Bott³

et al. 2005

Health Services Research

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Objective. To determine whether patients' use of the Veterans Health Administration health care system (VHA) is an independent risk factor for mortality following coronary artery bypass grafting (CABG) in the private sector in New York. Data Sources. VHA administrative and New York Department of Health Cardiac Surgery Reporting System (CSRS) databases for surgeries performed in 1999 and 2000. Study Design. Prospective cohort study comparing observed, expected, and risk‐adjusted mortality rates following private sector CABG for 2,326 male New York State residents aged 45 years and older who used the VHA (VHA users) and 21,607 who did not (non‐VHA users). Data Collection Methods. We linked VHA administrative databases to New York's CSRS to identify VHA users who obtained CABG in the private sector in New York in 1999 and 2000. Using CSRS risk factors and previously validated risk‐adjustment model, we compared patient characteristics and expected and risk‐adjusted mortality rates of VHA users to non‐VHA users. Principal Findings. Compared with non‐VHA users, patients undergoing private sector CABG who had used the VHA were older, had more severe cardiac disease, and were more likely to have the following comorbidities associated with increased risk of mortality: diabetes, chronic obstructive pulmonary disease, cerebrovascular disease, peripheral vascular disease, and history of stroke (p<.001 for all); a calcified aorta (p=.009); and a high creatinine level (p=.003). Observed (2.28 versus 1.80 percent) and expected (2.48 versus 1.78 percent) mortality rates were higher for VHA users than for non‐VHA users. The risk‐adjusted mortality rate for VHA users (1.70 percent; 95 percent confidence interval [CI]: 1.27–2.22) was not statistically different than that for the non‐VHA users (1.87 percent; 95 percent CI: 1.69–2.06). Use of the VHA was not an independent risk factor for mortality in the risk‐adjustment model. Conclusions. Although VHA users had a greater illness burden, use of the VHA was not found to be an independent risk factor for mortality following private sector CABG in New York. The New York Department of Health risk adjustment model adequately applies to veterans who obtain CABG in the private sector in New York.

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Section: Discussionmentioning

confidence: 99%

“…The model is validated annually. Similar models have been used in comparisons of in‐hospital mortality rates for CABG between the VHA and the private sector (Rosenthal, Vaughan Sarrazin, and Hannan 2003) and to track mortality rates for CABG within VHA (Shroyer et al 1995). …”

Section: Methodsmentioning

confidence: 99%

New York's Statistical Model Accurately Predicts Mortality Risk for Veterans Who Obtain Private Sector CABG

Weeks

Bazos²,

Bott³

et al. 2005

Health Services Research

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“…5, entitled Processes, Structures, and Outcomes of Care in Cardiac Surgery (PSOCS), a multicenter, prospective, observational study investigating the links between processes and structures of care and risk-adjusted outcomes. Details of the PSOCS study are published elsewhere 12,13 and are only reported here as relevant to the current analyses. Approximately 1500 variables representing patient-related risk factors, processes, structures, and outcomes of care were collected for a representative sample of 4969 patients who underwent cardiac surgery at 14 VA medical centers between September 1992 and December 1996.…”

Section: Subjectsmentioning

confidence: 99%

Health-Related Quality of Life as a Predictor of Mortality Following Coronary Artery Bypass Graft Surgery

Rumsfeld¹

1999

JAMA

399

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for the Participants of the Department of Veterans Affairs Cooperative Study Group on Processes, Structures, and Outcomes of Care in Cardiac Surgery C ORONARY ARTERY BYPASS GRAFT (CABG) surgery is one of the most common surgical procedures in the United States and requires considerable resources. In 1995, approximately 573 000 CABG surgeries were performed in the United States at an average cost of $44 820 per procedure. 1 Clinical decision making about whether to perform CABG surgery usually includes physician assessment of a patient's mortality risk from the procedure. Clinical predictors of mortality following CABG surgery can help guide physicians and patients in risk stratification. 2-4 Established clinical risk factors include a history of previous heart surgery, the severity of coronary artery disease, and the degree of comorbidity. There is an increasing interest in exploring health-related quality of life (HRQL) in relation to a given health care episode, such as CABG surgery. 5,6 Multiple self-report (by the patient)

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“…Some studies have linked organizational structure rather than clinical process to patient outcomes 1 , 26 . System research is complex because the number of variables involved in the process and the structure of care is exhaustless 27 . The processes of care are nested within organizations, so the organization affects both the structures and processes; as a result, organizational factors contribute to patient outcomes.…”

Section: Purposementioning

confidence: 99%

Perioperative Nurses and Patient Outcomes—Mortality, Complications, and Length of Stay

Newhouse¹,

Johantgen

Pronovost

et al. 2005

AORN Journal

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THE PURPOSE OF THE STUDY described in this article was to identify the relationship between RN staffing factors in the OR and surgical patient outcomes. THE STUDY ADDRESSED two main questions: whether the level of RN staffing in the OR is related to postoperative complications, mortality, and length of stay (LOS) and whether certification, RN agency use, 24-hour staffing, and the performance of multidisciplinary code drills are related to complications, mortality, and LOS. ACCORDING TO THIS STUDY, selected organizational factors in ORs had a significant influence on patient outcomes.

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The Processes, Structures, and Outcomes of Care in Cardiac Surgery Study Protocol

Cited by 16 publications

References 7 publications

New York's Statistical Model Accurately Predicts Mortality Risk for Veterans Who Obtain Private Sector CABG

New York's Statistical Model Accurately Predicts Mortality Risk for Veterans Who Obtain Private Sector CABG

Health-Related Quality of Life as a Predictor of Mortality Following Coronary Artery Bypass Graft Surgery

Perioperative Nurses and Patient Outcomes—Mortality, Complications, and Length of Stay

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