• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of amjphAmerican Journal of Public Health Web SiteAmerican Public Health Association Web SiteSubmissionsSubscriptionsAbout Us
Am J Public Health. 1994 October; 84(10): 1609–1614.
PMCID: PMC1615096

Comparing hospitals that perform coronary artery bypass surgery: the effect of outcome measures and data sources.


OBJECTIVES. The relative quality of hospital care often is judged by comparing risk-adjusted rates of adverse outcomes. This study evaluated whether hospital quality comparisons are affected by the choice of outcome and the use of administrative data instead of clinical data. METHODS. The data were collected from 2687 coronary artery bypass surgery patients from 17 hospitals. All patients were on Medicare. For 10 hospitals with 94 to 713 patients, risk-adjusted outcomes for death, major complications, and any complications were derived from a clinically rich database and an administrative database. RESULTS. The correlations between adjusted hospital rankings derived from the clinical and administrative databases were not significant: .48 for mortality, .21 for major complications, and -.14 for any complication. When only the clinical database was used, the correlation between risk-adjusted hospital rankings for mortality and major complications was .77 (P < .01) and the correlation between major complications and any complication was -.45. CONCLUSIONS. These results suggest assessing quality of care by the use of administrative data may not be adequate and that quality assessment by the use of clinical data may depend greatly on the outcome chosen.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.9M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Hannan EL, Kilburn H, Jr, O'Donnell JF, Lukacik G, Shields EP. Adult open heart surgery in New York State. An analysis of risk factors and hospital mortality rates. JAMA. 1990 Dec 5;264(21):2768–2774. [PubMed]
  • O'Connor GT, Plume SK, Olmstead EM, Coffin LH, Morton JR, Maloney CT, Nowicki ER, Tryzelaar JF, Hernandez F, Adrian L, et al. A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting. The Northern New England Cardiovascular Disease Study Group. JAMA. 1991 Aug 14;266(6):803–809. [PubMed]
  • Williams SV, Nash DB, Goldfarb N. Differences in mortality from coronary artery bypass graft surgery at five teaching hospitals. JAMA. 1991 Aug 14;266(6):810–815. [PubMed]
  • Hartz AJ, Kuhn EM, Kayser KL, Pryor DP, Green R, Rimm AA. Assessing providers of coronary revascularization: a method for peer review organizations. Am J Public Health. 1992 Dec;82(12):1631–1640. [PMC free article] [PubMed]
  • Wortman PM, Yeaton WH. Cumulating quality of life results in controlled trials of coronary artery bypass graft surgery. Control Clin Trials. 1985 Dec;6(4):289–305. [PubMed]
  • Bunzel B, Eckersberger F. Veränderung der Lebensqualität nach aortokoronarem Bypass und Klappenersatz: Ein Gradmesser des subjektiven Operationserfolges. Thorac Cardiovasc Surg. 1987 Aug;35(4):242–247. [PubMed]
  • Mayou R, Bryant B. Quality of life after coronary artery surgery. Q J Med. 1987 Mar;62(239):239–248. [PubMed]
  • King KB, Porter LA, Norsen LH, Reis HT. Patient perceptions of quality of life after coronary artery surgery: was it worth it? Res Nurs Health. 1992 Oct;15(5):327–334. [PubMed]
  • McAuliffe WE. Measuring the quality of medical care: process versus outcome. Milbank Mem Fund Q Health Soc. 1979 Winter;57(1):118–152. [PubMed]
  • Hannan EL, Kilburn H, Jr, Lindsey ML, Lewis R. Clinical versus administrative data bases for CABG surgery. Does it matter? Med Care. 1992 Oct;30(10):892–907. [PubMed]
  • Hannan EL, Bernard HR, O'Donnell JF, Kilburn H., Jr A methodology for targeting hospital cases for quality of care record reviews. Am J Public Health. 1989 Apr;79(4):430–436. [PMC free article] [PubMed]
  • Iezzoni LI. Using administrative diagnostic data to assess the quality of hospital care. Pitfalls and potential of ICD-9-CM. Int J Technol Assess Health Care. 1990;6(2):272–281. [PubMed]
  • Quam L, Ellis LB, Venus P, Clouse J, Taylor CG, Leatherman S. Using claims data for epidemiologic research. The concordance of claims-based criteria with the medical record and patient survey for identifying a hypertensive population. Med Care. 1993 Jun;31(6):498–507. [PubMed]
  • Iezzoni LI, Foley SM, Daley J, Hughes J, Fisher ES, Heeren T. Comorbidities, complications, and coding bias. Does the number of diagnosis codes matter in predicting in-hospital mortality? JAMA. 1992 Apr 22;267(16):2197–2203. [PubMed]
  • Romano PS, Mark DH. Bias in the coding of hospital discharge data and its implications for quality assessment. Med Care. 1994 Jan;32(1):81–90. [PubMed]
  • Jollis JG, Ancukiewicz M, DeLong ER, Pryor DB, Muhlbaier LH, Mark DB. Discordance of databases designed for claims payment versus clinical information systems. Implications for outcomes research. Ann Intern Med. 1993 Oct 15;119(8):844–850. [PubMed]
  • Wennberg JE, Roos N, Sola L, Schori A, Jaffe R. Use of claims data systems to evaluate health care outcomes. Mortality and reoperation following prostatectomy. JAMA. 1987 Feb 20;257(7):933–936. [PubMed]
  • DesHarnais S. Current uses of large data sets to assess the quality of providers. Construction of risk-adjusted indexes of hospital performance. Int J Technol Assess Health Care. 1990;6(2):229–238. [PubMed]
  • Luft HS, Garnick DW, Mark DH, Peltzman DJ, Phibbs CS, Lichtenberg E, McPhee SJ. Does quality influence choice of hospital? JAMA. 1990 Jun 6;263(21):2899–2906. [PubMed]
  • Fisher ES, Whaley FS, Krushat WM, Malenka DJ, Fleming C, Baron JA, Hsia DC. The accuracy of Medicare's hospital claims data: progress has been made, but problems remain. Am J Public Health. 1992 Feb;82(2):243–248. [PMC free article] [PubMed]
  • Brewster AC, Karlin BG, Hyde LA, Jacobs CM, Bradbury RC, Chae YM. MEDISGRPS: a clinically based approach to classifying hospital patients at admission. Inquiry. 1985 Winter;22(4):377–387. [PubMed]
  • Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985 Oct;13(10):818–829. [PubMed]
  • Iezzoni LI, Restuccia JD, Shwartz M, Schaumburg D, Coffman GA, Kreger BE, Butterly JR, Selker HP. The utility of severity of illness information in assessing the quality of hospital care. The role of the clinical trajectory. Med Care. 1992 May;30(5):428–444. [PubMed]
  • Weintraub WS, Jones EL, Craver J, Guyton R, Cohen C. Determinants of prolonged length of hospital stay after coronary bypass surgery. Circulation. 1989 Aug;80(2):276–284. [PubMed]
  • Geraci JM, Rosen AK, Ash AS, McNiff KJ, Moskowitz MA. Predicting the occurrence of adverse events after coronary artery bypass surgery. Ann Intern Med. 1993 Jan 1;118(1):18–24. [PubMed]
  • Higgins TL, Estafanous FG, Loop FD, Beck GJ, Blum JM, Paranandi L. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. A clinical severity score. JAMA. 1992 May 6;267(17):2344–2348. [PubMed]
  • Hammermeister KE, Burchfiel C, Johnson R, Grover FL. Identification of patients at greatest risk for developing major complications at cardiac surgery. Circulation. 1990 Nov;82(5 Suppl):IV380–IV389. [PubMed]
  • Huysmans HA, van Ark E. Predictors of perioperative mortality, morbidity and late quality of life in coronary bypass surgery. Eur Heart J. 1989 Dec;10 (Suppl H):10–12. [PubMed]
  • Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383. [PubMed]
  • Roos LL, Sharp SM, Cohen MM, Wajda A. Risk adjustment in claims-based research: the search for efficient approaches. J Clin Epidemiol. 1989;42(12):1193–1206. [PubMed]
  • Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992 Jun;45(6):613–619. [PubMed]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...