Quality of Cardiac Surgical Care in Ontario, Canada. Abstract and ExecutiveSummary of Thesis

摘要

In the dissertation, a comprehensive study was undertaken to evaluate a number ofissues related to the quality of cardiac surgical care in Ontario Canada. Data from the Provincial Adult Cardiac Care Network (PACCN) of Ontario cardiac surgery registry were used to conduct three studies. The first study demonstrated that the overall in-hospital mortality rate following coronary artery bypass graft (CABG) surgery in Ontario was 3.01% with no hospitals having risk-adjusted mortality rates significantly greater than expected during the 1991 to 1993 study period. The second study showed that higher rates of CABG surgery in New York State compared to Ontario in 1993 were a function of higher rates of surgery in the elderly, females, patients with a recent myocardial infarction, and patients with left main and limited coronary artery disease. The results of the third study suggest that artificial neural network modeling techniques do not offer any significant predictive advantages over existing logistic regression statistical techniques for predicting mortality after CABG surgery.