Why do outcomes of cabg care vary between urban and rural areas in Taiwan? A perspective from quality of care
Journal
International Journal for Quality in Health Care
Journal Volume
27
Journal Issue
5
Pages
361-368
Date Issued
2015
Author(s)
Abstract
Objective: This study explores the association between coronary artery bypass surgery (CABG) patients' residence and quality of care in terms of 30-day mortality. Design: A retrospective, multilevel study design was conducted using claims data from Taiwan's Universal Health Insurance Scheme. Hospital and surgeon's CABG operation volume, risk-adjusted surgical site infection rate and risk-adjusted 30-day mortality rate in the previous year were adopted as performance indicators, and the level of quality was evaluated via K-means clustering algorithm. Baron and Kenny's procedures for mediation effect were conducted. Setting: Hospitals in Taiwan. Participants: Patients who underwent CABG surgeries from 1 January 2008 to 30 September 2011 were identified in this study. However, patients who were under the age of 18 years or above the age of 85(n = 164), with missing data for gender (n = 3) or received surgeries from surgeons who never performed any CABG surgeries (n = 27), were excluded. Intervention(s): None. Main outcome measure(s): Thirty-day mortality. Results: There were 9973 CABG surgeries included in this study. Patients who lived in urban areas received better quality of care (28.90 vs. 21.57%) and enjoyed better outcome (4.33 vs. 6.84%). After the procedure of mediation effect testing, the results showed that the relationship between patient residence's urbanization level and 30-day mortality was partially mediated by patterns of quality of care. Conclusions: The rural-dwelling CABG patients are less likely to approach the better performing healthcare providers, and this tendency indirectly affects their treatment outcomes. Policymakers still need to develop strategies to ensure better equity in access to quality health care. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
Other Subjects
accreditation; adult; aged; Article; cardiac surgeon; controlled study; cross-sectional study; female; good clinical practice; health care policy; health care quality; human; infection rate; major clinical study; male; mortality; priority journal; retrospective study; surgical infection; Taiwan; treatment outcome; urban rural difference; urbanization; adolescent; age; algorithm; coronary artery bypass graft; demography; health care quality; insurance; middle aged; mortality; outcome assessment; sex difference; statistics and numerical data; very elderly; young adult; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Algorithms; Coronary Artery Bypass; Cross-Sectional Studies; Female; Humans; Insurance Claim Review; Male; Middle Aged; Outcome Assessment (Health Care); Quality Indicators, Health Care; Quality of Health Care; Residence Characteristics; Retrospective Studies; Sex Factors; Taiwan; Young Adult
Publisher
Oxford University Press
Type
journal article