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Invited Commentary |

Sex Differences in Hospital Risk-Adjusted Mortality Rates for Medicare Beneficiaries Undergoing CABG Surgery—Invited Commentary

Adrian F. Hernandez, MD, MHS; Sean M. O'Brien, PhD
Arch Intern Med. 2008;168(21):2323-2325. doi:10.1001/archinternmed.2008.516.
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Since the first hospital-specific performance reporting for CABG surgery over 20 years ago, continuous quality improvement has led to a steady and incremental decline in CABG mortality rates.1,2 This decline has occurred in the face of changing patient characteristics plus increased use of percutaneous procedures making the risk profile of surgical patients significantly higher than in prior decades.1 Reasons for improvement in reported outcomes are multifactorial and include significant attention to process of care coupled with improvements in cardiac surgery techniques. However, other potential reasons for improved reported outcomes may reflect differences in reporting rather than actual outcomes: patients might be shifted to other reporting categories, or lower-risk patients may be treated in higher-quality hospitals. While some researchers question whether reporting of outcomes has caused a true improvement in CABG outcomes or simply an improvement in reporting, significant evidence indicates that reporting performance measures effectively motivates physicians to improve their care.3 But the question always remains: “How can outcomes improve even more?”

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Figure.

Changes in performance tiers from 2006 to 2007 for risk-adjusted mortality rates (RAMR) of patients 65 years or older undergoing isolated coronary artery bypass graft (data from the Society of Thoracic Surgeons' National Cardiovascular Database14). A, Classification of 2006 tier 1 (best) hospitals by RAMR in 2007. B, Classification of 2006 tier 4 (worst) hospitals by RAMR in 2007.

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