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Indicator Metadata

Name30-Day All-Cause Readmission Rate After Isolated Coronary Artery Bypass Graft (CABG)
Short/Other Names

CABG Readmission

DescriptionRisk-adjusted rate of all-cause urgent readmission occurring within 30 days following discharge for an episode of care with an isolated coronary artery bypass graft (CABG) surgery. For further details, please see the CCQI General Methodology Notes.
InterpretationLower rates are desirable.
HSP Framework Dimension

Health System Outputs: Appropriate and effective

Areas of Need

Getting Better

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Facility

Indicator Results

https://www.cihi.ca/en/secure/health-system-performance/your-health-system-tools/data-preview-for-indicators

Identifying Information
Name30-Day All-Cause Readmission Rate After Isolated Coronary Artery Bypass Graft (CABG)
Short/Other Names

CABG Readmission

Indicator Description and Calculation
DescriptionRisk-adjusted rate of all-cause urgent readmission occurring within 30 days following discharge for an episode of care with an isolated coronary artery bypass graft (CABG) surgery. For further details, please see the CCQI General Methodology Notes.
Calculation: Description

The risk-adjusted rate for a facility is calculated by dividing the observed number of readmissions for each facility by the expected number of readmissions for the facility and multiplying by the Canadian average readmission rate.

Unit of analysis: Episode of care

An episode of care refers to all contiguous inpatient hospitalizations and same-day surgery visits. For episodes with transfers within or between facilities, transactions were linked regardless of diagnoses. For further details, please see the CCQI General Methodology Notes.

Calculation: Geographic Assignment

Place of service

Calculation: Type of Measurement

Rate - Rate - per 100

Calculation: Adjustment Applied

The following covariates are used in risk adjustment:
Age, sex, urgent admission, previous acute myocardial infarction, cardiac dysrhythmias, hypertension, multiple cardiac interventions, peripheral vascular disease, acute renal failure, Charlson Index

For detailed definitions of covariates and the risk-adjustment methodology, please refer to the CCQI General Methodology Notes.

Calculation: Method of Adjustment

Logistic regression

Denominator

Description:
Number of hospitalization episodes for patients age 18 and older who underwent an isolated CABG
Inclusions:
1. Episodes that had a CABG (CCI code 1.IJ.76.^^), where the intervention was not coded as out of hospital or abandoned (Out-of-Hospital Indicator not equal to Y and Intervention Status Attribute not equal to A)

2. Discharge date of end of episode between April 1 and March 1 of the fiscal year (to allow for a 30-day follow-up to capture readmissions occurring in the same fiscal year)
Exclusions:
1. In-hospital death (Discharge Disposition = 07)

2. Episodes with valve procedures (CCI codes 1.HS.^^ Therapeutic Interventions on the Tricuspid Valve, 1.HT.^^ Therapeutic Interventions on the Pulmonary Valve, 1.HU.^^ Therapeutic Interventions on the Mitral Valve, 1.HV.^^ Therapeutic Interventions on the Aortic Valve, 1.HW.^^ Therapeutic Interventions on the Annulus not elsewhere classified)

3. Episodes with core concomitant procedures. Please see the CCQI General Methodology Notes for the detailed list of procedures and codes.

Numerator

Description:
Number of hospitalization episodes in the denominator with an urgent readmission within 30 days of discharge after the CABG index episode of care
Inclusions:
1. Emergent or urgent (non-elective) readmission to an acute care hospital (Admission Category = U)

2. (Admission date on readmission record) − (Discharge date on the last record of the index episode of care) less than or equal to 30 days
Exclusions:
None

Background, Interpretation and Benchmarks
Rationale

Considering that about 2.4 million Canadians are living with heart disease and that Canada’s population is increasingly at risk,1 it’s important to examine the quality of cardiac care in order to support improvements in care and ultimately in the health of Canadians.

CABG, along with percutaneous coronary intervention (PCI), is a well-established procedure to treat coronary artery stenosis. Recently, there has been a large increase in the number of PCIs being performed as another revascularization option to treat coronary artery stenosis; the focus of CABG surgery has shifted to patients with more advanced coronary disease and comorbid conditions such as diabetes.2 30-day readmission after CABG has been identified as a key quality indicator for cardiac surgery care by the Canadian Cardiovascular Society.3

Urgent readmissions to acute care facilities are increasingly being used to measure institutional or regional quality of care and care coordination. Readmission rates can be influenced by a variety of factors, including patient characteristics, the quality of inpatient and outpatient care, the effectiveness of the care transition and coordination, and the availability and use of effective community-based disease management programs. While not all urgent readmissions are avoidable, interventions during and after a hospitalization can be effective in reducing readmission rates.

The indicator can provide direction for quality improvement and can help hospitals identify peers to facilitate knowledge sharing around best practices of care.

Interpretation

Lower rates are desirable.

HSP Framework Dimension

Health System Outputs: Appropriate and effective

Areas of Need

Getting Better

Targets/Benchmarks

Not applicable

References

1. Government of Canada. Heart disease — Heart health. Accessed February 2, 2017.

2. Deb S, et al. Coronary artery bypass graft surgery vs percutaneous interventions in coronary revascularization: A systematic review. JAMA. November 2013.

3. Canadian Cardiovascular Society. Quality Indicators for Cardiac Surgery. 2015.

Availability of Data Sources and Results
Data Sources

DAD, HMDB, NACRS

Available Data Years

Type of Year:
Fiscal
First Available Year:
2013
Last Available Year:
2015

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Facility

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Data Preview for Indicators tool
URL: https://www.cihi.ca/en/secure/health-system-performance/your-health-system-tools/data-preview-for-indicators

Updates

Please refer to the CCQI General Methodology Notes.

Quality Statement
Caveats and Limitations

– Cardiac care is delivered by many different health care professionals, and the resulting outcomes are a reflection of the whole system of care, rather than being attributable to a particular centre and/or physician.

– Indicator results do not provide a final conclusion about cardiac care performance but can be used as a first step in an improvement process to identify areas for follow-up and potential improvements.

– Cardiac Care Quality indicator results are influenced by individual patient characteristics that may not be captured in the risk-adjustment model. Only documented risk factors available in CIHI’s administrative databases are considered. However, the risk-adjustment model shows a predictive value (C-statistic) consistent with existing literature.

Trending Issues

Not applicable

Comments

This indicator belongs to a suite of Cardiac Care Quality indicators (CCQI) that provide nationally comparable information on outcomes related to selected cardiac interventions. The goal is to support monitoring and quality improvement in cardiac care.

More information on the CCQI Report is available in our information sheet.