Effect of benchmarking projects on outcomes of coronary artery bypass graft surgery: Challenges and prospects regarding the quality improvement initiative

Hiroaki Miyata, Noboru Motomura, Arata Murakami, Shinichi Takamoto

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: The Japan Cardiovascular Surgery Database (JCVSD) was established in 2000 and initiated a benchmarking project to improve the quality of cardiovascular surgery. Although the importance of quality improvement initiatives has been emphasized, few studies have reported the effects on outcomes. Methods: To examine the time-trend effects in initial JCVSD participants (n = 44), we identified 8224 isolated coronary artery bypass graft (CABG) procedures performed between 2004 and 2007. The impact of surgery year was examined using a multiple logistic regression model that set previously identified clinical risk factors and surgery year as fixed effects. To examine the difference in outcomes between initial participants (n = 44) and halfway participants (n = 55), we identified 3882 isolated CABG procedures performed in 2007. The differences between the 2 hospital groups were examined using a multiple logistic regression model that set clinical risk factors, hospital procedure volume, and hospital groups as fixed effects. Results: For operative mortality, the odds ratio of surgery year was 0.88 (P = .083). Observed/expected (OE) ratios for operative mortality were 0.71 in 2004, 0.73 in 2005, 0.63 in 2006, and 0.54 in 2007. As for composite mortality and major morbidities (reoperation, stroke, dialysis, infection, and prolonged ventilation), odds ratio of surgery year was 0.97 (P = .361). OE ratios for composite mortality and morbidities were 1.01 in 2004, 1.04 in 2005, 1.04 in 2006, and 0.94 in 2007. Compared with halfway participants, initial participants had a significantly lower rate of operative mortality (odds ratio = 0.527; P = .008) and composite mortality and major morbidities (odds ratio 0.820; P = .047). Conclusions: This study demonstrated that a quality improvement initiative for cardiovascular surgery has positive impacts on risk-adjusted outcomes. Although the primary target of benchmarking was 30-day mortality in Japan, major morbidities were less affected by those activities.

Original languageEnglish
Pages (from-to)1364-1369
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume143
Issue number6
DOIs
Publication statusPublished - 2012 Jun
Externally publishedYes

Fingerprint

Benchmarking
Quality Improvement
Coronary Artery Bypass
Transplants
Mortality
Logistic Models
Odds Ratio
Morbidity
Japan
Databases
Reoperation
Ventilation
Dialysis
Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Effect of benchmarking projects on outcomes of coronary artery bypass graft surgery : Challenges and prospects regarding the quality improvement initiative. / Miyata, Hiroaki; Motomura, Noboru; Murakami, Arata; Takamoto, Shinichi.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 143, No. 6, 06.2012, p. 1364-1369.

Research output: Contribution to journalArticle

@article{67b693202b5d4db0ae3c39568af40636,
title = "Effect of benchmarking projects on outcomes of coronary artery bypass graft surgery: Challenges and prospects regarding the quality improvement initiative",
abstract = "Objective: The Japan Cardiovascular Surgery Database (JCVSD) was established in 2000 and initiated a benchmarking project to improve the quality of cardiovascular surgery. Although the importance of quality improvement initiatives has been emphasized, few studies have reported the effects on outcomes. Methods: To examine the time-trend effects in initial JCVSD participants (n = 44), we identified 8224 isolated coronary artery bypass graft (CABG) procedures performed between 2004 and 2007. The impact of surgery year was examined using a multiple logistic regression model that set previously identified clinical risk factors and surgery year as fixed effects. To examine the difference in outcomes between initial participants (n = 44) and halfway participants (n = 55), we identified 3882 isolated CABG procedures performed in 2007. The differences between the 2 hospital groups were examined using a multiple logistic regression model that set clinical risk factors, hospital procedure volume, and hospital groups as fixed effects. Results: For operative mortality, the odds ratio of surgery year was 0.88 (P = .083). Observed/expected (OE) ratios for operative mortality were 0.71 in 2004, 0.73 in 2005, 0.63 in 2006, and 0.54 in 2007. As for composite mortality and major morbidities (reoperation, stroke, dialysis, infection, and prolonged ventilation), odds ratio of surgery year was 0.97 (P = .361). OE ratios for composite mortality and morbidities were 1.01 in 2004, 1.04 in 2005, 1.04 in 2006, and 0.94 in 2007. Compared with halfway participants, initial participants had a significantly lower rate of operative mortality (odds ratio = 0.527; P = .008) and composite mortality and major morbidities (odds ratio 0.820; P = .047). Conclusions: This study demonstrated that a quality improvement initiative for cardiovascular surgery has positive impacts on risk-adjusted outcomes. Although the primary target of benchmarking was 30-day mortality in Japan, major morbidities were less affected by those activities.",
author = "Hiroaki Miyata and Noboru Motomura and Arata Murakami and Shinichi Takamoto",
year = "2012",
month = "6",
doi = "10.1016/j.jtcvs.2011.07.010",
language = "English",
volume = "143",
pages = "1364--1369",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Effect of benchmarking projects on outcomes of coronary artery bypass graft surgery

T2 - Challenges and prospects regarding the quality improvement initiative

AU - Miyata, Hiroaki

AU - Motomura, Noboru

AU - Murakami, Arata

AU - Takamoto, Shinichi

PY - 2012/6

Y1 - 2012/6

N2 - Objective: The Japan Cardiovascular Surgery Database (JCVSD) was established in 2000 and initiated a benchmarking project to improve the quality of cardiovascular surgery. Although the importance of quality improvement initiatives has been emphasized, few studies have reported the effects on outcomes. Methods: To examine the time-trend effects in initial JCVSD participants (n = 44), we identified 8224 isolated coronary artery bypass graft (CABG) procedures performed between 2004 and 2007. The impact of surgery year was examined using a multiple logistic regression model that set previously identified clinical risk factors and surgery year as fixed effects. To examine the difference in outcomes between initial participants (n = 44) and halfway participants (n = 55), we identified 3882 isolated CABG procedures performed in 2007. The differences between the 2 hospital groups were examined using a multiple logistic regression model that set clinical risk factors, hospital procedure volume, and hospital groups as fixed effects. Results: For operative mortality, the odds ratio of surgery year was 0.88 (P = .083). Observed/expected (OE) ratios for operative mortality were 0.71 in 2004, 0.73 in 2005, 0.63 in 2006, and 0.54 in 2007. As for composite mortality and major morbidities (reoperation, stroke, dialysis, infection, and prolonged ventilation), odds ratio of surgery year was 0.97 (P = .361). OE ratios for composite mortality and morbidities were 1.01 in 2004, 1.04 in 2005, 1.04 in 2006, and 0.94 in 2007. Compared with halfway participants, initial participants had a significantly lower rate of operative mortality (odds ratio = 0.527; P = .008) and composite mortality and major morbidities (odds ratio 0.820; P = .047). Conclusions: This study demonstrated that a quality improvement initiative for cardiovascular surgery has positive impacts on risk-adjusted outcomes. Although the primary target of benchmarking was 30-day mortality in Japan, major morbidities were less affected by those activities.

AB - Objective: The Japan Cardiovascular Surgery Database (JCVSD) was established in 2000 and initiated a benchmarking project to improve the quality of cardiovascular surgery. Although the importance of quality improvement initiatives has been emphasized, few studies have reported the effects on outcomes. Methods: To examine the time-trend effects in initial JCVSD participants (n = 44), we identified 8224 isolated coronary artery bypass graft (CABG) procedures performed between 2004 and 2007. The impact of surgery year was examined using a multiple logistic regression model that set previously identified clinical risk factors and surgery year as fixed effects. To examine the difference in outcomes between initial participants (n = 44) and halfway participants (n = 55), we identified 3882 isolated CABG procedures performed in 2007. The differences between the 2 hospital groups were examined using a multiple logistic regression model that set clinical risk factors, hospital procedure volume, and hospital groups as fixed effects. Results: For operative mortality, the odds ratio of surgery year was 0.88 (P = .083). Observed/expected (OE) ratios for operative mortality were 0.71 in 2004, 0.73 in 2005, 0.63 in 2006, and 0.54 in 2007. As for composite mortality and major morbidities (reoperation, stroke, dialysis, infection, and prolonged ventilation), odds ratio of surgery year was 0.97 (P = .361). OE ratios for composite mortality and morbidities were 1.01 in 2004, 1.04 in 2005, 1.04 in 2006, and 0.94 in 2007. Compared with halfway participants, initial participants had a significantly lower rate of operative mortality (odds ratio = 0.527; P = .008) and composite mortality and major morbidities (odds ratio 0.820; P = .047). Conclusions: This study demonstrated that a quality improvement initiative for cardiovascular surgery has positive impacts on risk-adjusted outcomes. Although the primary target of benchmarking was 30-day mortality in Japan, major morbidities were less affected by those activities.

UR - http://www.scopus.com/inward/record.url?scp=84861169828&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861169828&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2011.07.010

DO - 10.1016/j.jtcvs.2011.07.010

M3 - Article

C2 - 22595627

AN - SCOPUS:84861169828

VL - 143

SP - 1364

EP - 1369

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 6

ER -