Heart patients in Pennsylvania were 22% more likely to survive a coronary artery bypass graft operation in 1995 than they were in 1991.
At the same time, costs for the CABG procedure leveled off and even dropped in the final year.
Those are the results from the latest report by the Pennsylvania Health Care Cost Containment Council, which was issued last week. The council issues the consumer guides every two years.
The Pennsylvania results are echoed on the national level, according to a study that appeared in last week's Journal of the American Medical Association.
Mortality of heart attack patients declined 10% over three years after an intensive application of clinical practice guidelines.
In the JAMA study, medical quality improvement organizations in four pilot states-Alabama, Connecticut, Iowa and Wisconsin-collected data on 250,000 cases in 1992. They then worked closely with physicians and hospitals to improve clinical procedures, using best-practices guidelines devised by the American Heart Association and the American College of Cardiology. When the quality experts did the same survey again in 1995, mortality was 10% lower.
Clifford Jones, executive director of the Pennsylvania council, said, "With quality on the rise and costs on the decline, this report suggests that the council's process of publicly reporting healthcare information is working."
For the first time the Pennsylvania report also included heart bypass surgery data by insurance plan.
The report showed the number of cardiac patients each health plan sent to each hospital in the state and the mortality rates and lengths of stay. All but one of the plans fell within the expected range of mortality for their patient types (See chart).
In 1994-1995, the period covered by the study, 91% of hospitals and 90% of surgeons had risk-adjusted mortality rates within the predicted range.
Joe Martin, a spokesman for the council, said that means "if you need a bypass operation in Pennsylvania, the overwhelming majority of hospitals and cardiac surgeons provide good to excellent care."
In 1994-1995, 3.8% of patients died compared with 4.9% in 1991, the council reported. At the same time, patient risk remained constant, and the number of CABG surgeries rose 25%.
Charges in 1994-1995 for a CABG ranged from $27,524 at Reading (Pa.) Hospital to $105,853 at Graduate Hospital in Philadelphia. The median was about $50,000. Graduate is part of Allegheny Health, Education and Research Foundation.