Elderly trauma inpatients in New York state: 1994-1998.

Background: The aging of the population in the United States has led to an increase in geriatric trauma. This study aimed to examine the characteristics and outcomes of geriatric trauma patients in New York State.

Methods: Four groups of elderly trauma patients (ages 40-64, 65-74, 75-84, and 85+ years) were contrasted with younger adults ages 13 to 39 years with respect to mechanism of injury, discharge disposition, hospital length of stay, comorbidities, and type of hospital in which they were treated.

Physical therapy and mobility 2 and 6 months after hip fracture.

Objectives: To examine the relationship between early physical therapy (PT), later therapy, and mobility 2 and 6 months after hip fracture.

Design: Prospective, multisite observational study.

Setting: Four hospitals in the New York City area.

Association of timing of surgery for hip fracture and patient outcomes.

Context: Previous studies of surgical timing in patients with hip fracture have yielded conflicting findings on mortality and have not focused on functional outcomes.

Objective: To examine the association of timing of surgical repair of hip fracture with function and other outcomes.

Design: Prospective cohort study including analyses matching cases of early (< or =24 hours) and late (>24 hours) surgery with propensity scores and excluding patients who might not be candidates for early surgery.

A review of the literature examining linkages between organizational factors, medical errors, and patient safety.

The potential role of organizational factors in enhanced patient safety and medical error prevention is highlighted in the systems approach advocated for by the Institute of Medicine and others. However, little is known about the extent to which these factors have been shown empirically to be associated with these favorable outcomes. The present study conducted an intensive review of the clinical and health services literatures in order to explore this issue.

A comparison of short- and long-term outcomes after off-pump and on-pump coronary artery bypass graft surgery with sternotomy.

Objectives: This study was designed to compare in-hospital mortality and complications and three-year mortality and revascularization for off-pump and on-pump coronary artery bypass graft (CABG) surgery after adjusting for patient risk.

Background: The use of off-pump CABG surgery has increased tremendously in recent years, but little is known about its long-term outcomes relative to on-pump CABG surgery, and most studies have been very small.

Methods: Short- and long-term outcomes (inpatient mortality and complications, three-year risk-adjusted mortality, and mortality/revascularization) were explored for patients who underwent off-pump CABG surgery (9135 patients) and on-pump CABG surgery (59044 patients) with median sternotomy from 1997 to 2000 in the state of New York.

Carotid endarterectomy utilization and mortality in 10 states.

Background: Studies that examined the rates of and mortality after carotid endarterectomy (CEA) mainly were confined to a limited geographical location or population. The primary purposes of this study are to examine the variation of risk-adjusted in-hospital mortality rates after CEA in 10 states, and utilization rates per capita of CEA.

Methods: An analysis was made of hospital discharge data from 10 states extracted from the Agency for Health Research and Quality national database, Healthcare Cost and Utilization Project (HCUP).

Severity of injury and mortality associated with pediatric blunt injuries: hospitals with pediatric intensive care units versus other hospitals.

Objective: To a) compare in-hospital mortality rates for pediatric (age <13 yrs) patients with blunt injuries in the New York State Trauma Registry based on hospital type (dedicated pediatric intensive care unit [PICU] and designated trauma centers and noncenters that do not have a dedicated PICU) for the purpose of determining whether there is a reduction in mortality at a specialty hospital and b) determine the extent to which high-risk patients are admitted to specialty hospitals.

Data Source: Inpatient data for the years 1994-1998 in the New York State Trauma Registry.

Study Selection: A total of 8,180 pediatric inpatients who suffered blunt injury were selected to examine where patients were treated (PICU, regional trauma center without PICU, area trauma center without PICU, or noncenter without PICU) as a function of injury severity.

Provider profiling and quality improvement efforts in coronary artery bypass graft surgery: the effect on short-term mortality among Medicare beneficiaries.

Context: In the last decade, a few states or regions in the United States have initiated efforts to publicly disseminate coronary artery bypass graft (CABG) surgery outcomes and/or formally initiate quality improvement programs for CABG surgery.

Objective: To compare CABG mortality rates and changes in CABG mortality rates in regions with quality improvement/public dissemination efforts with the remainder of the country.

Design, Setting, And Patients: Medicare data from 1994 to 1999 were used to develop a logistic regression model that predicts patient mortality for CABG surgery on the basis of preoperative patient risk factors and region of the country.

Predictors of readmission for complications of coronary artery bypass graft surgery.

Context: Risk factors for perioperative mortality after coronary artery bypass graft (CABG) surgery have been extensively studied. However, which factors are associated with early readmissions following CABG surgery are less clear.

Objective: To identify significant predictors of readmission within 30 days following CABG surgery.

Do hospitals and surgeons with higher coronary artery bypass graft surgery volumes still have lower risk-adjusted mortality rates?

Background: Studies that are the basis of recommended volume thresholds for CABG surgery are outdated and not reflective of recent advances in the field. This study examines both hospital and surgeon volume-mortality relations for CABG surgery through the use of a population-based clinical data set.

Methods And Results: Data from New York's clinical CABG surgery registry from 1997 to 1999 (total number of procedures, 57 150) were used to examine the individual and combined impact of annual hospital volume and annual surgeon volume on in-hospital mortality rates after adjusting for differences in severity of illness.

In-hospital mortality following coronary artery bypass graft surgery in Veterans Health Administration and private sector hospitals.

Objectives: Compare severity-adjusted in-hospital mortality in patients undergoing coronary artery bypass graft surgery (CABG) in VA and private sector hospitals in two geographic regions.

Research Design: Retrospective Cohort Study.

Subjects: Consecutive male patients undergoing CABG from October 1993 to December 1996 in: 43 VA hospitals with cardiac surgery programs (n = 19,266); 32 hospitals in New York (NY) State (n = 44,247); and 10 hospitals in Northeast (NE) Ohio (n = 9696).

Frequency and impact of active clinical issues and new impairments on hospital discharge in patients with hip fracture.

Background: Hip fracture is associated with significant mortality and disability. Patients who are discharged from the hospital with active clinical problems may have worse outcomes than those patients without active clinical problems.

Objective: To assess the frequency and impact of clinical problems at discharge on clinical and functional hip fracture outcomes.

Mortality in Medicare beneficiaries following coronary artery bypass graft surgery in states with and without certificate of need regulation.

Context: Certificate of need regulation was designed to control health care costs by preventing health care facilities from expanding unnecessarily. While there have been several studies investigating whether these regulations have affected health care investment, few have evaluated the relationship between certificate of need regulation and quality of care.

Objective: To compare risk-adjusted mortality and hospital volumes for coronary artery bypass graft (CABG) surgery in states with and without certificate of need regulation.

Impact of cardiac catheterization-percutaneous coronary intervention timing on inhospital mortality.

Background: It is more convenient and less costly to perform percutaneous coronary interventions (PCIs) in the catheterization laboratory after catheterization, but there is some doubt as to whether it is harmful to patients. Other studies on this topic have been hampered by small sample sizes and an inability to separate patients who underwent PCI after catheterization in the same admission from patients who underwent PCI in a subsequent admission.

Methods: Data from New York's PCI registry were used to develop a statistical model that predicted inhospital mortality based on preprocedural patient characteristics and the timing of the PCI (at same time as catheterization [combined procedure] or in the same admission as catheterization, but not at the same time [staged procedure]).

Hip fracture in the older patient: reasons for delay in hospitalization and timing of surgical repair.

Objectives: To quantify the interval between injury and hospitalization in older hip fracture patients, to quantify the time from hospital arrival to surgical repair of hip fracture, and to describe factors contributing to extended intervals between injury, hospitalization, and surgical repair of hip fracture.

Design: Prospective cohort study.

Setting: Four hospitals in the New York City metropolitan area.

Patients with hip fracture: subgroups and their outcomes.

Objectives: To present several alternative approaches to describing the range and functional outcomes of patients with hip fracture.

Design: Prospective study with concurrent medical records data collection and patient and proxy interviews at the time of hospitalization and 6 months later.

Setting: Four hospitals in the New York metropolitan area.

The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer.

Background: This study explores the volume-mortality relationship for 3 groups of cancer procedures to determine whether higher-volume hospitals, higher-volume surgeons, or both are associated with lower in-hospital mortality.

Methods: New York's Statewide Planning and Research Cooperative System was used to identify more than 32,000 hospital inpatients with a cancer diagnosis who underwent colectomy, lobectomy of the lung, or gastrectomy between January 1, 1994, and December 31, 1997. The association of in-hospital mortality rates with provider (hospital and surgeon) volume was examined after adjusting for differences in age, demographics, organ metastasis, socioeconomic status, and comorbidities.

Variability in cost of coronary bypass surgery in New York State: potential for cost savings.

Objective: Previous analyses of variability in bypass resource use have not focused on hospital-level variation or adequately explored the influence of patient risk. We combined a clinical database with claims data to fully characterize patient level and hospital level variability in bypass surgery cost and length of stay in New York State and explored the extent to which lower cost is associated with worse quality of care.

Methods: By use of 1992 clinical and claims data, we identified by multivariable regression which patient characteristics influence bypass cost and length of stay.

Association of surgical specialty and processes of care with patient outcomes for carotid endarterectomy.

Background And Purpose: Because there is considerable variation in practice patterns and outcomes for carotid endarterectomy (CE), there is a need to study the processes of care that are associated with adverse outcomes. The purpose of this study was to examine the impact of processes of care and surgical specialty on adverse outcomes for CE.

Methods: A retrospective cohort study based on a voluntary CE registry containing 3644 patients undergoing CE between April 1, 1997, and March 31, 1999, in New York hospitals was used in the study.

Motor vehicle crashes in New York State: importance of accounting for emergency department deaths when assessing differences in in-hospital mortality by level of care.

Background: Motor vehicle crashes (MVCs) are one of the leading causes of death in the nation and in New York State, particularly among younger adult males. It is important to study how to reduce mortality from MVCs.

Methods: Hospitalized victims of motor vehicle crashes in the 1994-1995 New York State Trauma Registry were identified for the study.

Differential survival after coronary revascularization procedures among patients with renal insufficiency.

Background: Acute myocardial infarction, cardiac arrest, and other cardiac events are the major cause of mortality among patients with renal insufficiency. Previous studies of interventions for coronary artery disease among patients with renal insufficiency have not controlled for potentially confounding factors such as coronary artery disease severity and left ventricular function. This study investigates the comparative survival for patients with renal insufficiency and coronary artery disease following coronary artery bypass graft (CABG) surgery as compared with percutaneous coronary artery intervention (PCI), while controlling for confounding factors.

Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes.

Context: Hip fracture is a common clinical problem that leads to considerable mortality and disability. A need exists for a practical means to monitor and improve outcomes, including function, for patients with hip fracture.

Objectives: To identify and compare the importance of significant prefracture predictors of functional status and mortality at 6 months for patients hospitalized with hip fracture and to compare risk-adjusted outcomes for hospitals providing initial care.

Predictors of mortality for patients undergoing cardiac valve replacements in New York State.

Background: The objective of this study was to identify the mortality rates and significant independent risk factors for mortality for each of six valve replacement groups.

Methods: A total of 14,190 patients who underwent valve replacement in New York State from 1995 to 1997 were classified into six major groups and significant independent risk factors for inpatient mortality were identified for each of the groups using stepwise logistic regression.

Results: Mortality rates ranged from 3.