Hannan E L, Kumar D, Racz M, Siu A L, Chassin M R
State University of New York, University at Albany.
Ann Thorac Surg. 1994 Dec;58(6):1852-7. doi: 10.1016/0003-4975(94)91726-4.
This study examined changes in the risk-adjusted mortality associated with coronary artery bypass grafting procedures performed in New York State during the first 4 years of New York's Cardiac Surgery Reporting System (1989 to 1992). To track performance over time, surgeons and hospitals were subdivided into three groups on the basis of their performance in 1989. The risk-adjusted mortality for each of the three groups was computed for 1992 and compared with their 1989 mortality. The results indicate that all groups of providers exhibited large reductions in the risk-adjusted mortalities, with the groups that showed the highest initial mortalities manifesting the most improvement. However, the group rankings remained the same in 1992 as they were in 1989. For example, when the hospital groups were based on the terciles of risk-adjusted mortality observed in 1989, the risk-adjusted mortality decreased from 2.72% to 2.19% for group 1, from 4.24% to 2.51% for group 2, and from 7.12% to 2.77% for group 3. Notably, the risk-adjusted mortalities of the three groups were all significantly different from one another in 1989, but were not significantly different from one another in 1992. Another interesting finding was that the volume of operations performed by the various provider groups did not change substantially in the 4-year period.
本研究调查了纽约心脏手术报告系统头4年（1989年至1992年）期间在纽约州进行的冠状动脉搭桥手术相关的风险调整死亡率的变化。为了追踪随时间推移的表现，外科医生和医院根据其1989年的表现被分为三组。计算了1992年这三组中每组的风险调整死亡率，并与它们1989年的死亡率进行比较。结果表明，所有医疗服务提供者组的风险调整死亡率都大幅降低，初始死亡率最高的组改善最为明显。然而，1992年组的排名与1989年相同。例如，当医院组基于1989年观察到的风险调整死亡率的三分位数划分时，第1组的风险调整死亡率从2.72%降至2.19%，第2组从4.24%降至2.51%，第3组从7.12%降至2.77%。值得注意的是，这三组的风险调整死亡率在1989年彼此显著不同，但在1992年彼此之间没有显著差异。另一个有趣的发现是，各医疗服务提供者组进行的手术量在这4年期间没有实质性变化。
