title: High cost patients for cardiac surgery and hospital quality in Turkey.
abstract: OBJECTIVE
  Encourage quality improvements and assess high expenditures for patients with coronary artery bypass graft (CABG) surgery and hospital quality in Turkey.
  
  
  METHODS
  Using the Turkish National Health Insurance Database (2009-2011), CABG surgery patients were identified using International Classification of Diseases Tenth Revision Clinical Modification codes. High-cost cardiac surgery patients had annual healthcare costs in the top 20% post-surgery. The empirical Bayes approach was used to combine mortality rates with hospital volume for quality index, weighing observed mortality according to estimation reliability, with the remaining weight placed on hospital volume. The relationship between hospital quality and high-cost payments was assessed using chi-square tests.
  
  
  RESULTS
  Total annual healthcare payments for 20,126 identified CABG patients were approximately €70 million. High-cost patients incurred 31% of the total expenditures. Although disease severity did not differ for patients across hospitals, those in the lowest quartile, in terms of quality, cared for 25% of high-costs surgery patients, compared with only 18% in the highest quality hospitals (p<0.0001). €4M in associated cost savings was calculated for patients shifting from low- to high-quality hospitals.
  
  
  CONCLUSIONS
  Results imply that hospital quality improvements can reduce costs and improve morbidity and mortality rates in Turkey.
authors.affiliation: The University of Michigan, Ann Arbor, USA. obaser@statinmed.com
authors.forename: Onur
authors.initials: O
authors.lastname: Baser
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Burkan
authors.forename: Erdem
authors.initials: E
authors.lastname: Baser
authors.forename: Rasim
authors.initials: R
authors.lastname: Koselerli
authors.forename: Emre
authors.initials: E
authors.lastname: Ertugay
authors.forename: Akif
authors.initials: A
authors.lastname: Altinbas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement / Q000191:economics / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000191:economics / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult