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Legacy Health System Comments on Heart Bypass Surgery (CABG):
Why is the CABG mortality rate higher at LegacyGood Samaritan Hospital? We have identified one important reason for this finding. Good Samaritan surgeons perform a higher proportion of “combination” surgeries than any other hospital in the state. These are surgeries where not only is a CABG performed, but the patient undergoes one or more heart valve replacements. These patients are much sicker and the surgery is riskier, with a significantly higher mortality rate. Of note is that the same group of surgeons also perform the heart surgeries at Legacy Emanuel, where the mortality rate is within the expected range. They tend to take the sicker patients to Good Samaritan for the more complex operations.
How is Legacy managing its quality processes?
Legacy staff regularly monitor mortality rates, along with many other indicators of care quality, in their efforts to provide the highest and safest care quality. Teams of physicians, nurses and administrators are constantly looking for new and better ways to reduce medication errors, infections, and other complications of the complex care processes provided in the hospital. Data such as these have long been part of that process and are viewed as an important part of our quality efforts.
How good a measure of quality is mortality?Reported mortality rates for hospitals represent a complex mix of factors. Most importantly, it has been shown that patient factors, such as severity of illness or pre-existing conditions, such as diabetes or heart failure, are the most powerful predictor of mortality rates. Often, institutions vary widely in what kind of patients they see and what patients are selected to undergo various treatments. A large, complex institution will tend to see sicker, more complex patients, as a rule. Thus, mortality rates for surgical procedures are often higher in tertiary care facilities. This is called patient selection bias. Severity-adjustment tools help correct for this kind of bias, but they are inexact. There are a variety of risk adjustment tools in existence, and we have seen as much as a 2-fold difference in expected mortality rates, depending on which risk adjustment tool is used.
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