The purpose of this assignment is to provide students with an opportunity to analyze data that was collected by the New York State Department of He

Data

Hospital

ADULT CARDIAC SURGERY in New York State 2011-2013

Department of Health

September 2016

Members of the New York State Cardiac Advisory Committee

Chair Spencer King III, M.D. Professor of Medicine, Emeritus Emory University School of Medicine Atlanta, GA

Vice Chair Gary Walford, M.D. Associate Professor of Medicine Johns Hopkins Medical Center Baltimore, MD

Members M. Hashmat Ashraf, M.D., FRCS Chief, Department of Cardiothoracic Surgery Kaleida Health Buffalo, NY

Peter B. Berger, M.D. Senior Vice President of Clinical Research and Interventional Cardiologist Professor of Cardiology and Medicine Northwell Health Hofstra – Northwell School of Medicine New Hyde Park, NY

Frederick Bierman, M.D. Director of Graduate Medical Education Westchester Medical Center Valhalla, NY

Jeptha Curtis, M.D. Asst. Professor, Dept. of Internal Medicine Director, Center for Outcomes Research & Evaluation Data Analytic Center Yale University School of Medicine New Haven, CT

Jeffrey P. Gold, M.D. Chancellor University of Nebraska Medical Center Omaha, NE

Alice Jacobs, M.D. Director, Cardiac Catheterization Laboratory & Interventional Cardiology Boston Medical Center Boston, MA

Desmond Jordan, M.D. Associate Professor of Clinical Anesthesiology in Biomedical Informatics NY Presbyterian Hospital – Columbia New York, NY

Thomas Kulik, M.D. Director, Pulmonary Hypertension Program Children’s Hospital Boston Boston, MA

Stephen Lahey, M.D. Chief, Division of Cardiothoracic Surgery University of Connecticut Health Center Farmington, CT

Frederick S. Ling, MD Professor in Medicine (Cardiology) University of Rochester Medical Center Rochester, NY

Ralph Mosca, M.D. Vice Chairman, Department of Cardiac Surgery Director, Congenital Cardiac Surgery NYU Medical Center

New York, NY

Carlos E. Ruiz, M.D., Ph.D. Professor of Cardiology in Pediatrics and Medicine Director, Structural and Congenital Heart Disease Hackensack University Medical Center Heart and Vascular Hospital The Joseph M. Sanzari Children’s Hospital Hackensack, NJ

Samin K. Sharma, M.D. Director, Cardiac Catheterization Laboratory Mount Sinai Medical Center New York, NY

Craig Smith, M.D. Chairman, Department of Surgery NY Presbyterian Hospital – Columbia New York, NY

Nicholas Stamato, M.D. Co-Director, Cardiology Campbell County Memorial Hospital Gilette, WY

Thoralf Sundt, III, M.D. Chief, Cardiac Surgical Division Co-Director, Heart Center and Institute for Heart, Vascular and Stroke Massachusetts General Hospital Boston, MA

James Tweddell, M.D. Surgical Director and Executive Co-Director The Heart Institute Professor of Surgery Cincinnati Children’s Hospital Medical Center Cincinnati, OH

Ferdinand Venditti, Jr., M.D. Executive Vice President for System Care Delivery Hospital General Director Vice Dean for Clinical Affairs Professor of Medicine Albany Medical Center Albany, NY

Andrew S. Wechsler, M.D. Professor and Chair, Department of Cardiothoracic Surgery Drexel University College of Medicine Philadelphia, PA

Consultant Edward L. Hannan, Ph.D. Distinguished Professor Emeritus Department of Health Policy, Management & Behavior Associate Dean Emeritus University at Albany, School of Public Health Rensselaer, NY

Cardiac Surgery Reporting System Subcommittee

Members & Consultants Craig Smith, M.D. (Chair) Chairman, Department of Surgery NY Presbyterian Hospital – Columbia

M. Hashmat Ashraf, M.D., FRCS Chief, Department of Cardiothoracic Surgery Kaleida Health

Jeffrey P. Gold, M.D. Chancellor University of Nebraska Medical Center

Edward L. Hannan, Ph.D. Distinguished Professor Emeritus Department of Health Policy, Management & Behavior Associate Dean Emeritus University at Albany, School of Public Health

Desmond Jordan, M.D. Associate Professor of Clinical Anesthesiology in Biomedical Informatics NY Presbyterian Hospital – Columbia

Stephen Lahey, M.D. Chief, Division of Cardiothoracic Surgery University of Connecticut Health Center

Ralph Mosca, M.D. Vice Chairman, Department of Cardiac Surgery Director, Congenital Cardiac Surgery NYU Medical Center

Carlos E. Ruiz, M.D., Ph.D. Professor of Cardiology in Pediatrics and Medicine Director, Structural and Congenital Heart Disease Hackensack University Medical Center Heart and Vascular Hospital The Joseph M. Sanzari Children’s Hospital

Nicholas J. Stamato, M.D. Co-Director, Cardiology Campbell County Memorial Hospital

Thoralf Sundt, III, M.D. Chief, Cardiac Surgical Division Co-Director, Heart Center and Institute for Heart, Vascular and Stroke Massachusetts General Hospital

James Tweddell, M.D. Surgical Director and Executive Co-Director The Heart Institute Professor of Surgery Cincinnati Children’s Hospital Medical Center

Andrew S. Wechsler, M.D. Professor and Chair, Department of Cardiothoracic Surgery Drexel University College of Medicine

Staff to CSRS Analysis Workgroup – New York State Department of Health Foster C. Gesten, MD Chief Medical Officer Office of Quality and Patient Safety, NYSDOH

Kimberly S. Cozzens, M.A. Program Manager Cardiac Services Program

Ashraf Al-Hamadani, MD, MPH Clinical Record Reviewer Cardiac Services Program

Lori Frazier Project Assistant Cardiac Services Program

Jessica Kincaid Quality Improvement Project Coordinator Cardiac Services Program

Rosemary Lombardo, M.S. CSRS Coordinator Cardiac Services Program

Leahruth Saavedra, MS Clinical Data Coordinator Cardiac Services Program

Zaza Samadashvili, M.D., M.P.H. Research Scientist Cardiac Services Program

TABLE OF CONTENTS

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

CORONARY ARTERY BYPASS GRAFT SURGERY (CABG) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

CARDIAC VALVE PROCEDURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

THE DEPARTMENT OF HEALTH PROGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

PATIENT POPULATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

RISK ADJUSTMENT FOR ASSESSING PROVIDER PERFORMANCE . . . . . . . . . . . . . . . . . . . . . . 11

Data Collection, Data Validation and Identifying In-Hospital/30-Day Deaths and 30-Day Readmission . . 11

Assessing Patient Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Predicting Patient Mortality Rates for Providers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Computing the Risk-Adjusted Mortality Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Interpreting the Risk-Adjusted Mortality Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Predicting Patient Readmission and Computing and Interpreting Risk-Adjusted Readmission Rates . . 13

How This Initiative Contributes to Quality Improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

DEFINITIONS OF KEY TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

2013 HOSPITAL OUTCOMES FOR CABG SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Table 1 In-Hospital/30-Day Observed, Expected and Risk-Adjusted Mortality Rates for Isolated CABG Surgery in New York State, 2013 Discharges. . . . . . . . . . . . . . 16

Figure 1 In-Hospital / 30-Day Risk-Adjusted Mortality Rates for Isolated CABG in New York State, 2013 Discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Table 2 30-Day Risk-Adjusted Readmission Rates for Isolated CABG in New York State, 2013 Discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Figure 2 30-Day Risk-Adjusted Readmission Rates for Isolated CABG in New York State, 2013 Discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

2011-2013 HOSPITAL OUTCOMES FOR VALVE SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Table 3 In-Hospital/30-Day Observed, Expected and Risk-Adjusted Mortality Rates for Valve or Valve/CABG Surgery in New York State, 2011-2013 Discharges . . . . . . . . . . . . 21

Figure 3 In-Hospital/30-Day Risk-Adjusted Mortali

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