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Description
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This indicator measures the age-standardized rate of coronary artery bypass graft (CABG) surgery performed on inpatients in acute care hospitals, per 100,000 population age 18 and older.

For further details, please see the General Methodology Notes.

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Calculation: Description
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(Total number of discharges for CABG for inpatients age 18 and older ÷ total mid-year population age 18 and older) × 100,000 (age adjusted)

Unit of Analysis: Single admission

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Calculation: Geographic Assignment
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Place of residence

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Calculation: Type of Measurement
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Rate - Per 100,000

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Calculation: Adjustment Applied
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Age-adjusted

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Calculation: Method of Adjustment
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Direct Standardization
Standard Population:
Canada 2011

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Denominator
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Description:
Total mid-year population age 18 and older

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Numerator
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Description:
Total number of discharges for CABG for inpatients age 18 and older

Inclusions:
1. CABG is identified as the following procedure code recorded in any position of the procedure code fields:

CCP: 48.1^

ICD-9-CM: 36.1

CCI: 1.IJ.76^^

2. Age at admission 18 years and older

3. Sex recorded as male or female

4. Admission to an acute care institution (Facility Type Code = 1)

5. Canadian resident (Canadian postal code)
Exclusions:
1. Procedures coded as out of hospital and abandoned after onset2. Newborn, stillbirth or cadaveric donor records (Admission Category = N, R or S)

2. CABG can be performed in designated cardiac centres only; therefore, procedures reported by facilities without on-site CABG services were excluded from the indicator calculation.

3. Procedures coded as out of hospital and abandoned after onset (Intervention Status Attribute = A or OOH Indicator Flag = Y)

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Rationale
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As with other types of surgical procedures, variation in CABG surgery rates can be attributed to numerous factors, including differences in population demographics, physician practice patterns and availability of services. In cases amenable to treatment with less-invasive procedures, percutaneous coronary intervention (PCI), an alternative intervention to improve blood flow to the heart muscle, may be used. Variations in the extent to which PCI is utilized may result in variations in the rate of bypass surgery.

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Interpretation
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Does not apply to this measure (i.e., there is no predefined preference for the measure score)

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HSP Framework Dimension
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Health System Inputs and Characteristics: Health system resources

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Areas of Need
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Not applicable

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Targets/Benchmarks
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Benchmarks have not been identified for this indicator.

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References
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Cardiac Care Network of Ontario Consensus Panel on Target Setting. Final Report and Recommendations. Toronto, Ont.: CCN, 2004. Accessed from <http://www.ccn.on.ca/ccn_public/UploadFiles/files/Cons_Panel_Target_Setting_FRR.pdf>.

Conigliaro, J. et al. "Understanding Racial Variation in the Use of Coronary Revascularization Procedures: The Role of Clinical Factors." Archives of Internal Medicine 160 (2000): pp. 1329-1335.

Faris, P. D. et al. "Diagnostic Cardiac Catheterization and Revascularization Rates for Coronary Heart Disease." Canadian Journal of Cardiology 20 (2004): pp. 391-397.

Institute for Clinical Evaluative Sciences. Cardiovascular Health and Services in Ontario. Toronto, Ont.: ICES, 1999.

Yap, A. G. et al. "Coronary Artery Bypass Surgery on Small Patients." Journal of Invasive Cardiology 12 (2000): pp. 242-246.

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Data Sources
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DAD, HMDB

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Available Data Years
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Type of Year:
Fiscal
First Available Year:
1997 2010
Last Available Year:
2014 2017

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Geographic Coverage
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All provinces/territories

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Reporting Level/Disaggregation
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National, Province/Territory, Region

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Update Frequency
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Every year

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Indicator Results
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Web Tool:
Health Indicators Ee-Publication
RLURL: http://www.cihi.ca/hirpt/?language=en

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Updates
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Not applicable

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Caveats and Limitations
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Some of the residents in New Brunswick's Zone 4 and Zone 5 receive CABG procedures in Quebec (there is under a referral agreement between Quebec and New Brunswick)the 2 provinces. Due to differences in data collection in MED-ECHO data, with or without Quebec data, we can not assign these patients to the regions, New Brunswick residents receiving care in Quebec cannot be assigned to their region of residence; thus the CABG rates for these 2 regions will be suppressed until they stop referring their patients to Quebecare suppressed.

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Trending Issues
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This data was not produced for fiscal year 2012–2013.Not applicable

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Comments
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CABG operations can be performed in designated cardiac centres only; therefore, procedures reported by facilities without on-site CABG services were excluded from the indicator calculation.

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