Coronary artery bypass graft surgery in New Zealand's Auckland region: a comparison between the clinical priority assessment criteria score and the actual clinical priority assigned.
OBJECTIVE
To describe the cohort of patients waiting for Coronary Artery Bypass Graft (CABG) surgery in the Auckland region; compare the Clinical Priority Assessment Criteria (CPAC) score with the actual priority assigned; and to assess the impact of a patient's demographic characteristics on the CPAC score and the assigned priority.


METHODS
An electronic register was developed to capture all patients who had a CPAC form completed for isolated CABG surgery during the period June 2002 to September 2004 in the Auckland region. CPAC scores and clinical priority assigned were collected from the CABG booking form. Demographic characteristics came from the booking form (age, gender) or linkage via the National Health Index (NHI) number (ethnicity, deprivation score).


RESULTS
The cohort displayed severe coronary artery disease and symptoms: 70% had class 3 or class 4 angina; 89% had their ability to work, live independently, or care for dependents threatened; 65% had three-vessel coronary disease; and 26% had left-main coronary disease. The CPAC score correlated only modestly with the actual clinical priority assigned, with an extremely wide range of scores for any given clinical priority. The mean CPAC score varied by the age of the patient, level of deprivation, and ethnicity--with higher mean scores among male patients who were Maori, Pacific, or more socioeconomically deprived. Clinical priority varied less by demographic characteristics than did the CPAC score, except more women than men were assigned the 'emergency' category. Despite higher CPAC scores for Maori and Pacific men, these did not translate to greater urgency in clinical priority.


CONCLUSIONS
The CPAC scoring system is used to limit access onto the CABG surgery waiting list in Auckland, but is not used to prioritise patients as to the urgency of surgery once on the list. The challenge is to determine why clinicians do not consider that the CPAC score is adequate to prioritise the urgency of surgery and to build in a process whereby any such score can be continuously evaluated and improved. We have demonstrated that the establishment of an electronic register of such patients can provide timely analysis of patterns of practice and could be used on a national scale to improve future CPAC scoring systems.
Seddon
Mary
M
Epidemiology and Biostatistics Section, Level 4, School of Population Health, University of Auckland, Auckland, New Zealand. m.seddon@auckland.ac.nz
Broad
Joanna
J
Crengle
Sue
S
Bramley
Dale
D
Jackson
Rod
R
White
Harvey
H
D000203:Activities of Daily Living / Q000145:classification; D017677:Age Distribution; D000368:Aged; D000787:Angina Pectoris / Q000145:classification; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology; D005080:Exercise Test / Q000145:classification; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D044469:Racial Groups / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D017678:Sex Distribution; D013318:Stroke Volume; D014850:Waiting Lists