DESCRIPTION (provided by applicant): The goal of this research program is to examine the comparative effectiveness of coronary artery bypass graft (CABG) procedures and percutaneous coronary artery interventions (PCI). This will be done by clinical enhancement of the New York State's Statewide Planning and Research Cooperative System (SPARCS) acute care hospital discharge database with hospital numerical laboratory data. Laboratory data will permit refinement of patient risk adjustment, provide full accountability of complications, and validate the accuracy of present-on-admission coding. Complete data sets from hospitals recruited into the project will allow analyses of 1) factors that influence whether coronary artery revascularization is performed by open surgical intervention or percutaneously, 2) short-term and long-term clinical outcomes of each chosen intervention by subsets of patients and subsets of hospitals, and 3) how alterations in selection of patients, procedures, and sites can improve short-term and long-term clinical outcomes of patients undergoing the different treatment options. Clinical outcomes will employ risk adjusted mortality rates, risk-adjusted length of stay in acute hospital facilities, and readmission/emergency department visits within 30 days of the index procedure. Precise risk adjustment will allow patient-level propensity matching models to be used, and clinical outcomes assessment can then be used for evaluation of hospital effectiveness. Year 1 will be invested in recruitment of participating hospitals and laboratory data enhancement of the SPARCS database, Year 2 will be used for refinement of protocols and initial analyses of data, and Year 3 will be devoted to final analyses with published reports and presentations. Results of these analytical evaluations can then be employed to provide feedback to providers so that optimum treatment strategies can be adopted for improved patient care using the comparative effectiveness paradigm.
PUBLIC HEALTH RELEVANCE: This project is designed to make hospital billing data collected by states more useful for studies of the comparative benefits of alternative medical treatments by linking billing records to laboratory test results obtained directly from hospitals' electronic databases. To demonstrate the value of the resulting clinically- enhanced billing database in guiding medical treatment decisions, patient outcomes after treatment of heart artery blockage by surgery and by balloon angioplasty will be compared using clinically-enhanced data and using complete clinical data from difficult-to-maintain cardiac registries. Successful development and use of new, relatively inexpensive to maintain enhanced billing databases to guide improvements in medical care will provide an important tool to ensure that each patient receives the right treatment performed in the right way at the right time.