Profiling hospital differences in the quality of CABG surgery using quality-adjusted life years
Joseph P Newhouse, Department of Health Care Policy, Harvard Medical School
Meredith B Rosenthal, Department of Health Policy and Management, Harvard School of Public Health
David M Shahian, Center for Quality and Safety; Department of Surgery, Massachusetts General Hospital
*Justin W Timbie, Veterans Affairs Ann Arbor Healthcare System, HSRD
Keywords: Quality of care, quality adjusted life years, provider profiling, health status, CABG surgery
We developed a summary measure of quality for hospitals performing CABG surgery using quality-adjusted life years (QALYs) to combine information on 10 process and complication measures with 2-year survival outcomes. To estimate QALYs we fit a survival model that includes the effects of failures on the 10 quality measures, and then weight each patient's predicted survival time with a disutility resulting from surgical complications. We compare each hospital’s QALY estimate to a “best hospital” benchmark—a theoretical hospital having a level of quality equal to the “best” observed rate for each of the 10 measures within our sample of hospitals. Our metric for profiling is “incremental QALYs.” The sample included 4070 patients undergoing isolated CABG surgery at 14 hospitals. Eight hospitals were considered low quality outliers with incremental QALY estimates statistically below zero.