Gender Differences in Hospital Survival Rates For Medicare Beneficiaries Undergoing Coronary Artery ...
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Gender Differences in Hospital Survival Rates For Medicare Beneficiaries Undergoing Coronary Artery Bypass Graft Surgery: Does Hospital Performance Ranking Matter. Steven D. Culler, PhD Associate Professor Rollins School of Public Health Emory University April Simon MRN President

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Steven D. Culler, PhD Associate Professor Rollins School of Public Health Emory University

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Steven d culler phd associate professor rollins school of public health emory university

Gender Differences in Hospital Survival Rates For Medicare Beneficiaries Undergoing Coronary Artery Bypass Graft Surgery: Does Hospital Performance Ranking Matter

Steven D. Culler, PhD

Associate Professor

Rollins School of Public Health

Emory University

April Simon MRN

President

Cardiac Data Solutions

Atlanta GA


Study objectives

Study Objectives

  • To report on gender differences in risk-adjusted mortality rates by hospital performance classes based on CABG outcomes among Medicare beneficiaries.

  • To identify the number of female Medicare beneficiary deaths that could be avoided by improving outcomes in bottom tier hospitals.


Methods data sources

Methods: Data Sources

  • Medicare Provide Analysis and Review File (MedPAR): An administrative database containing demographic information, 9 diagnostic and 6 procedure (ICD-9-CM) codes, and the discharge status of all Medicare beneficiaries admitted to any U.S. hospital.


Methods study period

Methods: Study Period

  • Study Period: October 1, 2002 to September 30, 2004 (Fiscal Years 2003 & 2004).


Methods study population

Methods: Study Population

Inclusion Criteria:

  • All Medicare beneficiaries undergoing a CABG surgery (Procedure codes of 36.10-36.19 and 36.2).

    Exclusion Criteria:

  • Patients having any concomitant valve surgery (Procedure codes of 35.00-35.04; 35.10-35.14; 35.20-35.28; & 35.31-35.39).

  • All patients in hospitals performing less than 52 surgeries per year or less than 17 surgeries on females per year.


Methods study sample

Methods: Study Sample


Methods analytic approach

Methods: Analytic Approach

  • Step 1: Annual Risk-Adjusted Mortality:

    A logistic regression equation (controlling for up to 25 demographic and co-morbid conditions) was estimated to predict each Medicare beneficiary’s probability of experiencing in-hospital mortality for each fiscal year.


Methods analytic approach1

Methods: Analytic Approach

  • Step 2: Annual Hospital Performance Tiers:

    Hospitals were annually ranked into quartiles based on the number of lives saved (or lost) - the difference between a hospital’s risk adjusted expected number of deaths and its observed number of deaths during the fiscal year.


Methods analytic approach2

Methods: Analytic Approach

  • Step 3: Annual Hospital Risk-Adjusted Mortality Rate by Gender:

    A male and female risk-adjusted mortality rate was calculated for each hospital for each fiscal year.


Results risk adjusted cabg mortality

Results: Risk-Adjusted CABG Mortality


Results risk adjusted cabg mortality1

Results: Risk-Adjusted CABG Mortality


Results gender difference between top and bottom tier

Results: Gender Difference Between Top and Bottom Tier


Issues alternative goals for bottom tier hospitals

Issues: Alternative Goals for Bottom Tier Hospitals

  • The females and males have the same risk-adjusted mortality rate in bottom tier hospitals;

  • The female risk-adjusted mortality rate in bottom tier hospitals improves to the average female risk-adjusted mortality rate; and

  • The female risk-adjusted mortality rate in bottom tier hospitals improves to the female risk-adjusted mortality rate in top tier hospitals.


Goal three bottom tier equals top tiers

Goal Three: Bottom Tier Equals Top Tiers


Summary

Summary:

  • Female Medicare beneficiaries had significantly higher risk-adjusted hospital mortality rates than males.

  • As one moves from the top quartile to the bottom quartile, the gender disparity in the risk-adjusted mortality rate increases.


Summary1

Summary:

  • Improvement Goal:

    85.3% of expected female beneficiaries deaths could be avoided if bottom tier hospitals achieved the same risk-adjusted outcomes as top tier CABG hospitals.


Limitations

Limitations:

  • Risk-adjusted models are based on co-morbid conditions identified from ICD-9-CM codes reported in an administrative dataset.

  • Gender differences for Medicare beneficiaries may not reflect gender differences for CABG surgery among younger patients.


Conclusion

Conclusion

Female Medicare beneficiaries should be much more selective in choosing where to have their CABG surgery performed!


The end

The End


Goal one no gender difference in bottom tier hospitals

Goal One: No Gender Difference in Bottom Tier Hospitals


Goal two bottom tier hospitals improve to the average female rate

Goal Two: Bottom Tier Hospitals Improve to the Average Female Rate


Methods analytic approach3

Methods: Analytic Approach

Risk-Adjustment: Demographic Variables:


Methods analytic approach4

Methods: Analytic Approach

Risk-Adjustment: History of Prior Procedures or Conditions:


Methods analytic approach5

Methods: Analytic Approach

Risk-Adjustment – Co-Morbid Conditions:


Methods analytic approach6

Methods: Analytic Approach

Risk-Adjustment: Co-Morbid Conditions


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