The CABG surgery volume-outcome relationship: temporal trends and selection effects in California, 1998-2004.

Health Services Research
James P MarcinPatrick S Romano

Abstract

To investigate the temporal trends in the volume-outcome relationship in coronary artery bypass graft (CABG) surgery in California from 1998 to 2004, and to assess the selection effects on this relationship by using data from periods of voluntary and mandatory hospital reporting. We used patient-level clinical data collected for the California CABG Mortality Reporting Program (CCMRP, a voluntary reporting program with between 68 and 81 hospitals) from 1998 to 2002 and the California CABG Outcomes Reporting Program (CCORP, a mandatory reporting program with 121 and 120 hospitals) from 2003 to 2004. The patient was the primary unit of analysis, and in-hospital mortality was the primary outcome. We used hierarchical logistic regression models (generalized linear mixed models) to assess the association of hospital annual volume with hospital mortality while controlling for detailed patient-level covariates in each of the 7 years. All data were systematically collected, reviewed for accuracy, and validated by the State of California's Office of Statewide Health Planning and Development (OSHPD). We found that during the period of voluntary hospital reporting (1998-2002), with the exception of 1998, higher volume hospitals had signifi...Continue Reading

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