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Comparison of the appropriateness of coronary angiography and coronary artery bypass graft surgery between Canada and New York State.

Publication ,  Journal Article
McGlynn, EA; Naylor, CD; Anderson, GM; Leape, LL; Park, RE; Hilborne, LH; Bernstein, SJ; Goldman, BS; Armstrong, PW; Keesey, JW
Published in: JAMA
September 28, 1994

OBJECTIVE: To compare the appropriateness of coronary angiography and coronary artery bypass graft (CABG) use between the United States and Canada. DESIGN: Retrospective randomized medical record review. SETTING: All hospitals performing coronary angiography and/or CABG surgery in two Canadian provinces (Ontario and British Columbia); in New York State, 15 randomly selected hospitals that provide coronary angiography and 15 randomly selected hospitals that provide CABG surgery. PATIENTS: All patients were randomly selected. For coronary angiography, 533 patients in Canada and 1333 patients in New York were selected; for CABG, 556 patients in Canada and 1336 patients in New York were selected. MAIN OUTCOME MEASURES: Percentage of patients in each country who had coronary angiography or CABG for necessary, appropriate, uncertain, or inappropriate indications as rated by criteria developed separately in each country and the complications of those procedures. RESULTS: For coronary angiography, 9% of Canadian cases and 10% of New York cases were rated inappropriate using Canadian criteria compared with 5% and 4%, respectively, using US criteria. For CABG, 4% of Canadian cases and 6% of New York cases were rated inappropriate by Canadian criteria compared with 3% and 2%, respectively, using US criteria. A lower proportion of procedures were performed on persons aged 75 years or older in Canada than in New York for both coronary angiography (5% vs 11%; P < .001) and CABG (6% vs 14%; P < .001). Women were also represented in lower proportions among angiography cases in Canada than in New York (28% vs 35%; P = .023). Canadian patients with left main coronary disease waited significantly longer between angiography and CABG than did New York patients (P < .0001). CONCLUSIONS: Rates of inappropriate use of cardiac procedures were low in Canada and New York, which suggests that the regionalization of cardiac procedures that characterizes both health care systems contributes to better clinical decision making. Differences in the use of cardiac procedures among the elderly in the two countries merits further comparative examination.

Duke Scholars

Published In

JAMA

ISSN

0098-7484

Publication Date

September 28, 1994

Volume

272

Issue

12

Start / End Page

934 / 940

Location

United States

Related Subject Headings

  • Utilization Review
  • Treatment Outcome
  • Technology Assessment, Biomedical
  • Practice Patterns, Physicians'
  • Postoperative Complications
  • Ontario
  • New York
  • Middle Aged
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
McGlynn, E. A., Naylor, C. D., Anderson, G. M., Leape, L. L., Park, R. E., Hilborne, L. H., … Keesey, J. W. (1994). Comparison of the appropriateness of coronary angiography and coronary artery bypass graft surgery between Canada and New York State. JAMA, 272(12), 934–940.
McGlynn, E. A., C. D. Naylor, G. M. Anderson, L. L. Leape, R. E. Park, L. H. Hilborne, S. J. Bernstein, B. S. Goldman, P. W. Armstrong, and J. W. Keesey. “Comparison of the appropriateness of coronary angiography and coronary artery bypass graft surgery between Canada and New York State.JAMA 272, no. 12 (September 28, 1994): 934–40.
McGlynn EA, Naylor CD, Anderson GM, Leape LL, Park RE, Hilborne LH, et al. Comparison of the appropriateness of coronary angiography and coronary artery bypass graft surgery between Canada and New York State. JAMA. 1994 Sep 28;272(12):934–40.
McGlynn EA, Naylor CD, Anderson GM, Leape LL, Park RE, Hilborne LH, Bernstein SJ, Goldman BS, Armstrong PW, Keesey JW. Comparison of the appropriateness of coronary angiography and coronary artery bypass graft surgery between Canada and New York State. JAMA. 1994 Sep 28;272(12):934–940.
Journal cover image

Published In

JAMA

ISSN

0098-7484

Publication Date

September 28, 1994

Volume

272

Issue

12

Start / End Page

934 / 940

Location

United States

Related Subject Headings

  • Utilization Review
  • Treatment Outcome
  • Technology Assessment, Biomedical
  • Practice Patterns, Physicians'
  • Postoperative Complications
  • Ontario
  • New York
  • Middle Aged
  • Male
  • Humans