title: Why do outcomes of CABG care vary between urban and rural areas in Taiwan? A perspective from quality of care.
abstract: OBJECTIVE
  This study explores the association between coronary artery bypass surgery (CABG) patients' residence and quality of care in terms of 30-day mortality.
  
  
  METHODS
  A retrospective, multilevel study design was conducted using claims data from Taiwan's Universal Health Insurance Scheme. Hospital and surgeon's CABG operation volume, risk-adjusted surgical site infection rate and risk-adjusted 30-day mortality rate in the previous year were adopted as performance indicators, and the level of quality was evaluated via K-means clustering algorithm. Baron and Kenny's procedures for mediation effect were conducted.
  
  
  METHODS
  Hospitals in Taiwan.
  
  
  METHODS
  Patients who underwent CABG surgeries from 1 January 2008 to 30 September 2011 were identified in this study. However, patients who were under the age of 18 years or above the age of 85(n = 164), with missing data for gender (n = 3) or received surgeries from surgeons who never performed any CABG surgeries (n = 27), were excluded.
  
  
  METHODS
  None.
  
  
  METHODS
  Thirty-day mortality.
  
  
  RESULTS
  There were 9973 CABG surgeries included in this study. Patients who lived in urban areas received better quality of care (28.90 vs. 21.57%) and enjoyed better outcome (4.33 vs. 6.84%). After the procedure of mediation effect testing, the results showed that the relationship between patient residence's urbanization level and 30-day mortality was partially mediated by patterns of quality of care.
  
  
  CONCLUSIONS
  The rural-dwelling CABG patients are less likely to approach the better performing healthcare providers, and this tendency indirectly affects their treatment outcomes. Policymakers still need to develop strategies to ensure better equity in access to quality health care.
authors.affiliation: Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
authors.forename: Tsung-Hsien
authors.initials: TH
authors.lastname: Yu
authors.affiliation: Department of Chinese Medicine, Tao Yuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.
authors.forename: Yu-Chang
authors.initials: YC
authors.lastname: Hou
authors.affiliation: Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
authors.forename: Yu-Chi
authors.initials: YC
authors.lastname: Tung
authors.affiliation: Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan kpchung@ntu.edu.tw.
authors.forename: Kuo-Piao
authors.initials: KP
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D013624:Taiwan; D055815:Young Adult
keywords: CABG; health inequality; quality of care; rural and urban disparity