How well do hospital mortality rates reported in the New York State CABG report card predict subsequent hospital performance?
BACKGROUND
The use of mortality report cards as the basis for hospital choice assumes that a hospital's current performance is predicted by its past performance.


OBJECTIVE
To assess the accuracy of hospital risk-adjusted mortality rates reported in the New York State (NYS) coronary artery bypass graft (CABG) report card for predicting subsequent hospital mortality.


METHODS
We performed a retrospective study based on hospital mortality measures for CABG surgery (n = 37 hospitals) in NYS, which are publicly reported by the NYS Department of Health. Feasible generalized least squares was used to examine the association between a hospital's past quality ranking (high-quality, intermediate-quality, low-quality) and its subsequent performance, as measured using the ratio of the observed-to-expected mortality rate (O-to-E ratio).


RESULTS
Hospitals identified as low-mortality hospitals using 2-year-old data had subsequent O-to-E ratios that were 16.8% lower (95% confidence interval, 8.9-24.8; P < 0.001) than average-mortality hospitals, whereas hospitals identified as high-mortality hospitals had subsequent O-to-E ratios that were 31.8% higher (95% confidence interval, 3.69-59.9; P < 0.05) compared with average-mortality hospitals. Hospitals identified as high-mortality hospitals using 3-year-old data were indistinguishable from average-mortality hospitals.


CONCLUSIONS
Hospital ranking based on 2-year-old data is a strong predictor of future performance. Report cards based on 3-year-old data may not be useful for identifying low-performance hospitals. We recommend that the CABG report cards in NYS should be based on 2-year-old data, as opposed to the current practice of basing them on either 2- or 3-year-old data.
Glance
Laurent G
LG
Department of Anesthesiology, University of Rochester School of Medicine, Rochester, NY 14642, USA. Laurent_Glance@urmc.rochester.edu
Dick
Andrew W
AW
Mukamel
Dana B
DB
Li
Yue
Y
Osler
Turner M
TM
D001026:Coronary Artery Bypass / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D020379:Risk Adjustment; D013997:Time Factors