Griffith B P, Hattler B G, Hardesty R L, Kormos R L, Pham S M, Bahnson H T
Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA.
Ann Surg. 1995 Oct;222(4):593-8; discussion 598-9. doi: 10.1097/00000658-199510000-00015.
The authors review the Pennsylvania Health Care Cost Containment Council reports on coronary artery surgery and compare this reporting structure to others, including the Society for Thoracic Surgeons database, currently used by their own program. The authors review the growing likelihood of a need for outcome measures for all of the surgical subspecialties.
Pressure from consumers and insurers will require surgical specialties to be graded by objective outcome measures. Practitioners must be prepared and become involved in the process.
The authors reviewed the data, which grades all of Pennsylvania's hospitals at which coronary artery bypass is performed. Apparently, the major risk factors commonly employed in most other risk adjustment schemes for cardiac surgery have been deleted, and the practitioners might be judged unfairly. The Pennsylvania system appears to be insurance driven to reward low-cost providers who operate on patients with the lowest risk.
Review of data suggests that the Pennsylvania Health Care Cost Containment Council's annual publication, A Consumer's Guide for Coronary Artery Bypass Surgery, misrepresents fair risk adjustment in favor of lower-risk patients, thereby encouraging better score cards for those institutions with patients who are less ill. Data regarding charges for the procedure have not been risk adjusted or related to a regional economic index.
Surgeons must prepare to better understand relevant models that evaluate outcome. Cardiothoracic surgery is one of the first specialties to feel the pressures of mandated evaluations, and the lessons learned in Pennsylvania should be applicable to other states and their practitioners.
作者回顾了宾夕法尼亚医疗成本控制委员会关于冠状动脉手术的报告，并将该报告结构与其他报告结构进行比较，包括他们自己的项目目前使用的胸外科医师协会数据库。作者回顾了所有外科亚专业对结果指标需求增加的可能性。
来自消费者和保险公司的压力将要求对外科亚专业进行客观结果指标的分级。从业者必须做好准备并参与到这个过程中。
作者回顾了对宾夕法尼亚州所有进行冠状动脉搭桥手术的医院进行分级的数据。显然，大多数其他心脏手术风险调整方案中常用的主要风险因素已被删除，从业者可能会受到不公平的评判。宾夕法尼亚州的系统似乎是由保险驱动的，旨在奖励那些为风险最低的患者做手术的低成本提供者。
数据回顾表明，宾夕法尼亚医疗成本控制委员会的年度出版物《冠状动脉搭桥手术消费者指南》在有利于低风险患者方面歪曲了公平风险调整，从而鼓励那些接收病情较轻患者的机构获得更好的评分。该手术费用的数据未进行风险调整，也未与区域经济指数相关联。
外科医生必须准备好更好地理解评估结果的相关模型。心胸外科是首批感受到强制评估压力的专业之一，在宾夕法尼亚州吸取的经验教训应适用于其他州及其从业者。
