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Quality Care, Not Number of Procedures, Determines Bypass Results
Date:4/22/2008

pping back to 9.1 per 1,000 patients by 2003. During that same time span, the number of angioplasties tripled.

And from 1997 to 2003, the number of hospitals doing large numbers of cardiac bypass surgery dropped from 32.5 percent to 15.5 percent. Despite this shift, however, the death rate after cardiac bypass surgery dropped from 5.4 percent in 1988 to 3.3 percent in 2003, the researchers found.

What's more, the largest decrease in death rates was among the hospitals that performed the fewest cardiac bypass operations.

Ricciardi's team believes its findings show that using death rates after cardiac bypass surgery may no longer be an accurate gauge of the quality of care provided by a hospital.

"Measuring quality is obviously difficult," Ricciardi said. "Trying to determine which hospital will give you the best outcome, and where you get the best quality medicine, is very difficult to determine based solely on surgical volume."

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, said he agrees with the findings. And they mirror the conclusions of other studies, he added.

"This new study adds to other recent studies which suggest that volume of cardiovascular procedures is, in and of itself, not a useful indicator of quality of care or patient outcomes," he said.

"The very good news from this study is that in-hospital mortality rates for CABG are improving at U.S. hospitals, irrespective of CABG volume," Fonarow said.

Fonarow said the volume of procedures should not continue to be used as a measure of quality care.

"The practice of health-care payers and accrediting organizations in using volume of procedures such as CABG surgery as quality criteria for hospitals should be replaced with more accurate and direct measures of quality of care and patient-centered clinical outcomes," he said.

Another expert, Dr. Samin Sharma, dir
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