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Steven D. Culler, PhD Associate Professor Rollins School of Public Health Emory University

Gender Differences in Hospital Survival Rates For Medicare Beneficiaries Undergoing Coronary Artery Bypass Graft Surgery: Does Hospital Performance Ranking Matter. Steven D. Culler, PhD Associate Professor Rollins School of Public Health Emory University April Simon MRN President

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Steven D. Culler, PhD Associate Professor Rollins School of Public Health Emory University

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  1. Gender Differences in Hospital Survival Rates For Medicare Beneficiaries Undergoing Coronary Artery Bypass Graft Surgery: Does Hospital Performance Ranking Matter Steven D. Culler, PhD Associate Professor Rollins School of Public Health Emory University April Simon MRN President Cardiac Data Solutions Atlanta GA

  2. Study Objectives • To report on gender differences in risk-adjusted mortality rates by hospital performance classes based on CABG outcomes among Medicare beneficiaries. • To identify the number of female Medicare beneficiary deaths that could be avoided by improving outcomes in bottom tier hospitals.

  3. Methods: Data Sources • Medicare Provide Analysis and Review File (MedPAR): An administrative database containing demographic information, 9 diagnostic and 6 procedure (ICD-9-CM) codes, and the discharge status of all Medicare beneficiaries admitted to any U.S. hospital.

  4. Methods: Study Period • Study Period: October 1, 2002 to September 30, 2004 (Fiscal Years 2003 & 2004).

  5. Methods: Study Population Inclusion Criteria: • All Medicare beneficiaries undergoing a CABG surgery (Procedure codes of 36.10-36.19 and 36.2). Exclusion Criteria: • Patients having any concomitant valve surgery (Procedure codes of 35.00-35.04; 35.10-35.14; 35.20-35.28; & 35.31-35.39). • All patients in hospitals performing less than 52 surgeries per year or less than 17 surgeries on females per year.

  6. Methods: Study Sample

  7. Methods: Analytic Approach • Step 1: Annual Risk-Adjusted Mortality: A logistic regression equation (controlling for up to 25 demographic and co-morbid conditions) was estimated to predict each Medicare beneficiary’s probability of experiencing in-hospital mortality for each fiscal year.

  8. Methods: Analytic Approach • Step 2: Annual Hospital Performance Tiers: Hospitals were annually ranked into quartiles based on the number of lives saved (or lost) - the difference between a hospital’s risk adjusted expected number of deaths and its observed number of deaths during the fiscal year.

  9. Methods: Analytic Approach • Step 3: Annual Hospital Risk-Adjusted Mortality Rate by Gender: A male and female risk-adjusted mortality rate was calculated for each hospital for each fiscal year.

  10. Results: Risk-Adjusted CABG Mortality

  11. Results: Risk-Adjusted CABG Mortality

  12. Results: Gender Difference Between Top and Bottom Tier

  13. Issues: Alternative Goals for Bottom Tier Hospitals • The females and males have the same risk-adjusted mortality rate in bottom tier hospitals; • The female risk-adjusted mortality rate in bottom tier hospitals improves to the average female risk-adjusted mortality rate; and • The female risk-adjusted mortality rate in bottom tier hospitals improves to the female risk-adjusted mortality rate in top tier hospitals.

  14. Goal Three: Bottom Tier Equals Top Tiers

  15. Summary: • Female Medicare beneficiaries had significantly higher risk-adjusted hospital mortality rates than males. • As one moves from the top quartile to the bottom quartile, the gender disparity in the risk-adjusted mortality rate increases.

  16. Summary: • Improvement Goal: 85.3% of expected female beneficiaries deaths could be avoided if bottom tier hospitals achieved the same risk-adjusted outcomes as top tier CABG hospitals.

  17. Limitations: • Risk-adjusted models are based on co-morbid conditions identified from ICD-9-CM codes reported in an administrative dataset. • Gender differences for Medicare beneficiaries may not reflect gender differences for CABG surgery among younger patients.

  18. Conclusion Female Medicare beneficiaries should be much more selective in choosing where to have their CABG surgery performed!

  19. The End

  20. Goal One: No Gender Difference in Bottom Tier Hospitals

  21. Goal Two: Bottom Tier Hospitals Improve to the Average Female Rate

  22. Methods: Analytic Approach Risk-Adjustment: Demographic Variables:

  23. Methods: Analytic Approach Risk-Adjustment: History of Prior Procedures or Conditions:

  24. Methods: Analytic Approach Risk-Adjustment – Co-Morbid Conditions:

  25. Methods: Analytic Approach Risk-Adjustment: Co-Morbid Conditions

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