July 27th, 2010
CABG in the Real World
Larry Husten, PHD
Two studies in Archives of Internal Medicine look at different aspects of CABG in the real world. Auerbach and colleagues analyzed data from more than 80,000 CABG patients and found that quality can be improved and costs reduced by directing patients away from low-volume surgeons and hospitals in favor of higher-volume surgeons and hospitals. However, the results also showed that quality improvement efforts aimed at increasing adherence to process measures can improve outcomes and lower costs. In an accompanying editorial, David Brown writes about the numerous deficiencies in current methods used to measure outcomes after CABG: “After more than 40 years of performance of CABG surgery, it is time to put the patient at the center of discussion, planning, and research about clinical outcomes and quality.”
In the second study, Popescu and colleagues found that black patients with acute MI or undergoing CABG were “equally or more likely” than whites to receive treatment at top-ranked hospitals, with the exception of socially disadvantaged black CABG patients. In an invited commentary, Michelle Albert writes that “multiple social and medical factors converge to determine black-white differences in receipt of cardiovascular care, of which presentation to top-ranked cardiac hospitals represents only the tip of the iceberg.”
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