technical note for the california report on coronary … citation: state of california, office of...

Technical Note

For

The California Report on

Coronary Artery Bypass Graft Surgery 2013-2014:

Hospital and Surgeon Data

May 2017

Prepared by University of California, Davis School of Medicine CABG Research Team

for the Office of Statewide Health Planning and Development

Suggested citation: State of California, Office of Statewide Health Planning and Development. The California Report on Coronary Artery Bypass Graft Surgery, 2013-2014: Hospital and Surgeon Data, Sacramento, CA: Office of Statewide Health Planning and Development, May 2017. Copies of this document and other CABG surgery-related reports may be found at www.osphd.ca.gov

http://www.osphd.ca.gov/

TECHNICAL NOTES FOR THE CALIFORNIA REPORT ON CORONARY ARTERY BYPASS GRAFT SURGERY, 2013-2014: HOSPITAL AND SURGEON DATA

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TABLE OF CONTENTS Introduction ................................................................................................................................................................................ 1

Data Quality Review and Verification ................................................................................................................................ 2

Risk Model for Adjusting Hospital and Surgeon Isolated CABG Operative Mortality Rates, 2013-2014 .. 4 Hospital Risk-Adjusted Operative Mortality Results for Isolated CABG, 2014 .................................................................... 7 Surgeon Risk-Adjusted Operative Mortality Results for Isolated CABG, 2013-2014 ...................................................... 17

Risk Model for Adjusting Hospital CABG + Valve Operative Mortality Rates, 2013-2014........................... 85 Hospital CABG + Valve Operative Mortality Results, 2013-2014 ........................................................................................... 88

Risk Model for Adjusting Hospital Post-Operative Stroke Rates, 2013-2014................................................. 99 Hospital Risk-Adjusted Post-Operative Stroke Results, 2013-2014 ................................................................................... 101

Hospital Internal Mammary Artery Usage Results, 2014 ..................................................................................... 113

Appendix A: Definition of Terms ................................................................................................................................... 118

Appendix B: Hospital Statements .................................................................................................................................. 120

Appendix C: Acknowledgments ...................................................................................................................................... 122


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TABLES

Table A: Study Populations Used in Measures (by Year, Exclusion Criteria and Denominator) .................................2

Table B: California CABG Surgery Volume, 2013-2014 ..................................................................................................................3

Table C-1: Logistic Regression Risk Model for Isolated CABG Operative Mortality, 2013-2014 .................................5

Table C-2: Calibration of Risk Model for Isolated CABG Operative Mortality, 2013-2014 ..............................................6

Table C-3: Hospital Risk-Adjusted Mortality Results by Region, 2014 ....................................................................................8

Table C-4: Surgeon Risk-Adjusted Mortality Results, 2013-2014 ........................................................................................... 18

Table D-1: Logistic Regression Risk Model for CABG + Valve Operative Mortality, 2013-2014 ............................... 85

Table D-2: Calibration of Risk Model for CABG + Valve Operative Mortality, 2013-2014............................................ 87

Table D-3: Hospital Risk-Adjusted CABG + Valve Operative Mortality Results by Region, 2013-2014 ................. 89

Table E-1: Logistic Regression Risk Model for Post-Operative Stroke, 2013-2014 ........................................................ 99

Table E-2: Calibration of Risk Model for Post-Operative Stroke, 2013-2014 ................................................................. 101

Table E-3: Hospital Risk-Adjusted Post-Operative Stroke Results by Region, 2013-2014 ....................................... 103

Table F-1: Hospital Internal Mammary Artery Usage Results by Region, 2014............................................................. 114


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Introduction This technical note describes the research methods used to develop the California CABG Outcomes Reporting Program’s (CCORP) report: The California Report on Coronary Artery Bypass Graft (CABG) Surgery in California, 2013-2014: Hospital and Surgeon Data. This report is produced by the Office of Statewide Health Planning and Development (OSHPD) in compliance with California Health and Safety Code Sections 128745-128750 and can be found at: OSHPD CABG Reports. See Appendix A for definitions of the technical terms used in this document.

Hospital and Surgeon Performance Measures Reported

This report provides hospital performance data on four key measures of CABG surgery quality: Outcome measures

• Isolated CABG operative mortality • CABG + valve operative mortality • Post-operative stroke (isolated CABG)

Process measure • Use of the internal mammary artery (isolated CABG)

This report also provides surgeon performance data on one outcome measure isolated CABG operative mortality. The three outcome measures are risk-adjusted to account for variation in the health status of patients prior to CABG surgery. Note: risk-adjusted readmission rates for 2014 are not included in this report; instead, a two-year measure (2014 and 2015) will be included in the next public report. Future readmission results will continue to combine two years of data to improve the stability of the risk-adjusted rates and minimize the impact to hospitals with patients difficult to track across multiple points of accessing care. Measure Definitions:

Operative mortality is defined as a patient death occurring in the hospital after CABG surgery (regardless of the length of stay) or death occurring anywhere after hospital discharge but within 30 days of the CABG surgery. Use of operative mortality instead of in-hospital mortality avoids potential manipulation of outcomes through early discharge practices and holds hospitals accountable for patients who died at home or in other facilities shortly after discharge. The National Quality Forum (NQF), which serves as the national body for vetting quality measures, has endorsed the national Society of Thoracic Surgeons (STS) operative mortality measure for CABG surgery.1 CCORP uses the STS definition of operative mortality and also verifies deaths following patient discharge using death records from the California Department of Public Health (CDPH).

1 National Quality Forum (NQF). National voluntary consensus standards for quality measurement, Washington, DC: National Quality Forum. In 2015, NQF updated its endorsement of the risk-adjusted operative mortality for isolated CABG measure by STS (#0119). Details can be found at NQF QPS.

http://www.oshpd.ca.gov/HID/CABG-Report.html

http://www.qualityforum.org/QPS/QPSTool.aspx


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o Isolated CABG surgery is defined as CABG surgery performed on patients aged 18 years or older without other major procedures, such as valve repair or carotid endarterectomy, during the same surgery. A detailed definition of isolated CABG surgery is on pages 55-56 of the training manual: http://www.oshpd.ca.gov/documents/HID/CORC/TrainingManualV6-3.pdf

o CABG + valve surgery is defined as CABG surgery performed on patients aged 18 years or older that includes aortic valve replacement, mitral valve replacement or repair, or a combination thereof.

Post-operative stroke is defined as a post-operative, central neurologic deficit that did not resolve within 24 hours after surgery. Use of the internal mammary artery (IMA) is the preferred method for CABG surgery of the left anterior descending (LAD) artery. Research shows that high rates of IMA use result in long-term graft patency and improved patient survival.

Data Quality Review and Verification

Study Population Under state law, California-licensed hospitals are required to report all isolated and non-isolated CABG surgeries to OSHPD. The study populations for the measures vary by data year and exclusion criteria (Table A). Table A. Study Populations Used in Measures (by Year, Exclusion Criteria, and Denominator)

Measure Study Population Data Year(s)

Isolated CABG Operative Mortality

Hospital: Total number of isolated CABG cases without salvage operative status 2014

Surgeon: Total number of isolated CABG cases without salvage operative status 2013-2014

CABG + Valve Operative Mortality

Total number of aortic valve replacement, mitral valve repair or mitral valve replacement (or a combination) plus CABG cases without salvage operative status

2013-2014

Post-Operative Stroke

Total number of isolated CABG cases without salvage operative status 2013-2014

Internal Mammary Artery Usage

First-time, non-cardiogenic shock, isolated CABG surgeries discharged where the operative status was elective or urgent and the left anterior descending (LAD) artery was bypassed

2014

For 2013 and 2014, there were 31,261 adult CABG surgeries performed in California (Table B). Of these, 24,092 (77.1%) were isolated CABG surgeries and 7,169 (22.9%) were non-isolated CABG surgeries. The study population for most outcomes in this report consists of all adult patients who underwent isolated CABG surgery and were discharged in 2014. However, to improve statistical power for CABG + valve cases and post-operative stroke results, the study population includes those patients who were discharged in 2013 or 2014.

http://www.oshpd.ca.gov/documents/HID/CORC/TrainingManualV6-3.pdf


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Table B. California CABG Surgery Volume, 2013-2014

CABG Type 2013 2014 2013-2014 Combined Cases % Cases % Cases % Isolated CABGs 11,940 76.8% 12,164 77.4% 24,092 77.1% CABG + Valve 2,642 17.0% 2,490 16.0% 5,132 16.4% Other Non-isolated CABGs 964 6.2 % 1,073 6.8% 2,037 6.5% All CABGs 15,546 100% 15,715 100% 31,261 100%

*Table excludes all CABG salvage cases.

Data Sources and Quality The primary data source for this report is the 2013 and 2014 clinical data registry collected by CCORP from 127 hospitals and 271 surgeons. These data were linked to death records from CDPH to identify patients who died at home or at facilities other than the operating hospital within 30 days following CABG surgery. These data were also linked to OSHPD’s PDD to identify patients who were discharged alive and were readmitted to a hospital within 30 days of CABG surgery. The CCORP clinical data registry primarily consists of data elements from the STS Adult Cardiac Surgery Database. However, it also includes a few data elements exclusive to CCORP. Although STS and CCORP data definitions are generally identical, CCORP provides additional clarifications to assist hospitals with coding. All data elements and their definitions can be found in the training manual at: http://www.oshpd.ca.gov/documents/HID/CORC/TrainingManualV6-3.pdf CCORP reviews the data submitted by each hospital for completeness and errors. Using a three-step data quality review and verification process, CCORP asks hospitals to check data quality, data discrepancies, and potential risk-factor coding problems.

Step 1: Data Collection and Acceptance

Hospitals report their data using CCORP’s online clinical data collection system, Cardiac Online Reporting for California (CORC). Automated data acceptance reports notify hospitals of invalid, missing and abnormally high or low data values. Data quality reports are also generated each time a hospital submits data. Hospitals review these summary reports before they adjust, finalize and certify their data submission.

Step 2: Data Discrepancy Reports

Data discrepancy reports compare the CCORP clinical registry data to the OSHPD PDD file (the hospital administrative data record). Hospitals are asked to review and account for discrepancies between the two data sources via patient medical chart review to verify that 1) all CABG surgeries discharged were reported; 2) each CABG was accurately coded as isolated or non-isolated CABG surgery; 3) coding of Discharge Status was consistent; 4) Resuscitation occurred prior to CABG surgery; and 5) coding of post-operative complications (including strokes) was consistent. Step 3: Risk-Factor Coding Reports

Risk-factor coding reports identify values that may be extreme by comparing the hospital-reported prevalence rates in the current year to prior years and to the administrative

http://www.oshpd.ca.gov/documents/HID/CORC/TrainingManualV6-3.pdf


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data from the PDD. CCORP requests hospitals to review and, when necessary, correct miscoded data elements.

Hospital Medical Chart Audit After completing the data quality review and verification process, CCORP develops a preliminary risk model for operative mortality and post-operative stroke to help identify candidate hospitals for an on-site medical chart audit. Candidate selection for the 2014 audit was based on results of the preliminary model which identified “Better” or “Worse” hospital performers and on data quality reports that identified problems in hospitals over- and under-reporting patient-risk factors. Additionally, a small number of hospitals were randomly selected for audit. The 2014 audit included 36 hospitals and a total of 2,627 patient records (28.6% of 126 hospitals and approximately 16.7% of all CABG surgery cases in 2014). On-site medical chart reviews were conducted by trained, independent auditors under contract with OSHPD. All hospital deaths and post-operative strokes at selected hospitals were audited and high-risk patients, based on predicted mortality, were sampled at a higher rate. The number of patient records selected within a hospital was proportional to the isolated CABG volume of the hospital, but generally ranged from 60 to 140 cases. If a selected hospital performed fewer than 40 isolated CABG surgeries per year, all surgeries were audited. Individual audit summary reports were sent to each hospital for review and comment.

Risk Model for Adjusting Hospital and Surgeon Isolated CABG Operative Mortality Rates, 2013-2014 This section explains the development and validation of CCORP’s risk model that accounts for the variation in patient severity of illness for hospital and surgeon operative mortality. CCORP used a multivariable logistic regression model to estimate the relationship between the demographic and pre-operative risk factors and the probability of operative mortality. To develop the risk model for hospital and surgeon mortality rates, the 12,164 isolated (non-salvage) CABG surgery cases in 2014 were evaluated for missing data; 10,207 cases had no missing data in any field and were used for the risk model parameter estimation. The 1,957 (16%) isolated CABG cases with missing data fields were removed to ensure that the effects of risk factors were estimated based on the most complete data available. To generate the hospital and surgeon specific results shown in this report, missing values for these 1,957 records were imputed (after risk model parameter estimation) by replacing them with the lowest risk category of the same variable (e.g., Chronic Lung Disease = none). CCORP assigned the lowest risk value for the following reasons: 1) some hospitals leave data fields blank by design when the risk factor is absent or the value is normal; 2) maintains consistency with other major cardiac reporting programs that replace missing data with the lowest-risk or normal value; and 3) creates an incentive for more complete reporting by hospitals. After imputing the missing values, the parameters of the risk model were applied to all cases to estimate each patient’s probability of death. CCORP summed these probabilities to estimate the expected mortality for each hospital. The risk model, based on the 2014 data, is presented in Table C-1 with statistically significant risk factors identified in bolded text.


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Table C-1: Logistic Regression Risk Model for Isolated CABG Operative Mortality, 2013-2014

Risk Factor Coefficient Standard Error P-value Odds Ratio

Intercept -7.8494 0.7477 <.0001

Age (Years) 0.0297 0.0076 <.0001 1.031

Gender Male Reference

Female 0.4572 0.15.72 0.0042 1.568

Race White Reference

Non-White 0.0506 0.1514 0.7272 1.054

Body Mass Index 18.5-39.9 Reference

<18.5 0.5659 0.5349 0.2975 1.745 ≥40.0 0.7744 0.2903 0.0079 2.157

Status of the Procedure Elective Reference

Urgent 0.4714 0.2129 0.0307 1.583 Emergent 0.8487 0.3807 0.0283 2.308

Last Creatinine Level (mg/dl) 0.7626 0.2498 0.0024 2.126 Hypertension -0.0932 0.2544 0.7035 0.908 Peripheral Arterial Disease 0.4958 0.1806 0.0066 1.634 Cerebrovascular Disease 0.4023 0.2391 0.0986 1.484 Cerebrovascular Accident 0.1200 0.2846 0.6309 1.146 Chronic Lung Disease Severe vs. None, Mild, and Moderate 0.1767 0.3097 0.4849 1.24

Arrhythmia Afib/Flutter 0.3345 0.2028 0.0859 1.416 Arrhythmia Vtach 0.2200 0.3178 0.4441 1.275

Timing of Myocardial Infarction (MI)

No MI or 21 or more days Reference

8-20 days ago 0.6852 0.2533 0.0055 2.02 1-7 days ago 0.4260 0.1876 0.0191 1.551

Within 24 Hours 0.7667 0.3383 0.0230 2.155 Cardiogenic Shock 1.0960 0.3854 0.0036 3.056 Heart Failure 0.2951 0.1924 0.1016 1.369 NYHA Classification IV vs. I,II,III 0.0207 0.2340 0.9214 1.023

Prior Cardiac Surgery First Operation Reference

Second or Later Operation 0.8681 0.3543 0.0147 2.376

Interval from Prior PCI to Surgery

No Prior PCI Reference

Prior PCI > 6 HRS -0.0826 0.1723 0.0770 0.932 Prior PCI <= 6 HRS 0.9093 0.4285 0.6822 2.437

Ejection Fraction (%) -0.0091 0.0057 0.1255 0.991 Left Main Disease (≥ 50%) -0.1193 0.1542 0.4215 0.885

None, One, or Two Reference


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Table C-1: Logistic Regression Risk Model for Isolated CABG Operative Mortality, 2013-2014

Risk Factor Coefficient Standard Error P-value Odds Ratio

Number of Diseased Vessels Three or more 0.1488 0.1862 0.4173 1.163

Mitral Insufficiency None/Trivial/Mild Reference

Moderate/Severe 0.3653 0.2025 0.0663 1.449 MELD (Model for End-Stage Liver Disease) Score 10 0.3550 0.1932 0.063 1.431

Bolded text indicates statistically significant. Note: Last Creatinine Level and Ejection Fraction were modeled using piecewise linear transformations. Discrimination of Risk Model for Operative Mortality A commonly used measure of discrimination is the C-statistic, also known as the area under the Receiver Operating Characteristic (ROC) curve. For all possible pairs of patients, where one dies and the other survives surgery, the C-statistic describes the proportion of pairs where the patient who died had a higher predicted risk of death than the patient who lived. C-statistics range from 0.5 to 1, with higher values indicating better discrimination. For the 2014 risk model, the C-statistic was 0.794. In the most recently published CABG surgery mortality reports by other states (New Jersey, New York, and Pennsylvania), the C-statistics ranged from 0.791 to 0.836.

Calibration of Risk Model for Operative Mortality A common measure of calibration is the Hosmer-Lemeshow χ2 test, which compares observed and predicted outcomes over deciles of risk. The p-value of the Hosmer-Lemeshow test statistic for this 2014 risk model is 0.117, and there were no systematic over- or under-estimations at the extreme deciles of risk. A second calibration test sorts the data into 10 risk groups and compares observed deaths with predicted deaths in each of 10 risk groups. As presented in Table C-2, Risk Group 10 shows the patients in the highest risk group. Among the 1,013 patients in Group 10, 89 patients died, and the model predicted 89.48 patient deaths. Assuming a Poisson distribution for a binary outcome, the predicted range of deaths for Risk Group 10 is 71.90 to 110.05. The observed number of 89 deaths falls within the range of predicted deaths. None of the risk groups showed an observed death outside the predicted death 95% confidence interval. The model slightly under-predicted deaths in three of the 10 risk groups and none of the risk groups had significantly fewer or significantly more deaths than were predicted by the model. Table C-2: Calibration of Risk Model for Isolated CABG Operative Mortality, 2013-2014

Risk Group

Isolated CABG Cases

Observed Deaths

Predicted Deaths Difference 95%CI of Predicted Deaths

1 1020 2 3.54 1.54 0.87 9.60 2 1020 3 5.16 2.16 1.71 11.90 3 1020 2 6.60 4.60 2.57 13.89 4 1020 6 8.18 2.18 3.57 16.01


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5 1022 6 10.14 4.14 4.89 18.57 6 1020 19 12.69 -6.31 6.70 21.84 7 1020 22 16.39 -5.61 9.44 26.47 8 1020 26 22.36 -3.64 14.07 33.74 9 1020 34 34.46 0.46 23.93 48.05

10 1013 89 89.48 0.48 71.90 110.05 Note: Risk Group 1 is at lowest risk for mortality and Risk Group 10 is at highest risk.

Process for Calculating Hospital and Surgeon Risk-Adjusted Mortality Rates and Performance Rating The risk-adjusted mortality rate (RAMR) is computed by dividing the provider’s observed mortality by the provider’s expected mortality (obtained from the risk model calculation) to get the observed/expected (O/E) ratio. The O/E ratio is then multiplied by the statewide mortality rate (1.97% in 2014 and 2.13% in 2013-2014) to obtain the provider’s risk-adjusted mortality rate. However, because a provider’s point estimate of the RAMR can be attributed to chance, the performance rating is not based on a point estimate of the RAMR, but a comparison of the 95% confidence interval (CI) of each provider’s RAMR to the statewide mortality rate.2 CCORP treated the 2013 and 2014 data as a sample, and inferred a range within which each provider’s true performance was likely to fall. As shown in Tables C-3 and C-4, a provider’s performance rating is “Better” if the upper 95% CI of a provider’s risk-adjusted mortality is below the state average mortality rate (indicating the provider’s RAMR is significantly lower than the state average). A provider’s performance rating is “Worse” if the lower 95% CI of a provider’s RAMR is above the state average mortality rate (indicating the provider’s risk-adjusted mortality is significantly higher than the state average). If the state average mortality rate is within the 95% CI of a provider’s RAMR, then the performance rating is “Average.”

Hospital Risk-Adjusted Operative Mortality Results for Isolated CABG, 2014 Among the 12,152 isolated and non-salvage CABG surgeries performed at 127 hospitals in 2014, 239 patients died either in-hospital or within 30 days of the surgery date, reflecting a statewide operative mortality rate of 1.97%. The observed mortality rates among hospitals ranged from 0% to 16.88%. The expected mortality rates, which are generated by the risk model and account for patient severity-of-illness, were between 0.69% and 5.52%. The RAMRs, which measure hospital performance, ranged from 0% to 15.72%. Based on the 95% confidence intervals for the RAMRs, 125 of 127 hospitals (98%) performed within the expected range when compared to the statewide mortality rate, and two hospitals performed significantly “Worse” than the state average (Community Regional Medical Center-Fresno and Desert Regional Medical Center) (Table C-3).

2 CCORP uses the Poisson Exact Probability method to compute the 95% confidence interval for the risk-adjusted mortality rate. (Buchan Iain, Calculating Poisson Confidence Interval in Excel, January 2004).


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Table C-3: Hospital Risk-Adjusted Mortality Results by Region, 2014

Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG

Mortality

Observed Mortality Rate (%)

Expected Mortality Rate (%)

Risk-Adjusted Mortality Rate

(%, RAMR) 95% CI for

RAMR Performance

Rating*

State 15,715 12,152 239 1.97

Sacramento Valley & Northern California Region

Enloe Medical Center – Esplanade Campus 155 130 2 1.54 2.32 1.30 (0.16, 4.70) Average

Mercy General Hospital 663 413 3 0.73 1.78 0.80 (0.17, 2.34) Average

Mercy Medical Center – Redding 148 128 4 3.13 3.01 2.04 (0.56, 5.22) Average

Mercy San Juan Hospital 119 85 1 1.18 1.73 1.33 (0.03, 7.44) Average

Rideout Memorial Hospital 108 91 4 4.40 2.42 3.57 (0.97, 9.15) Average

Shasta Regional Medical Center 64 55 1 1.82 2.01 1.78 (0.05, 9.92) Average

St. Joseph Hospital – Eureka 24 17 1 5.88 2.45 4.73 (0.12, 26.35) Average

Sutter Memorial Hospital 443 315 2 0.63 1.96 0.64 (0.08, 2.30) Average

UC Davis Medical Center 120 80 2 2.50 1.28 3.84 (0.46, 3.86) Average

San Francisco Bay Area & San Jose

Alta Bates Summit Medical Center – Summit Campus – Hawthorne

137 115 0 0.00 1.77 0.00 (0.00, 3.57) Average

California Pacific Medical Center – Pacific Campus 75 57 1 1.75 2.91 1.19 (0.03, 6.61) Average

Community Hospital of the Monterey Peninsula 122 89 2 2.25 2.16 2.04 (0.25, 7.38) Average

Dominican Hospital – Santa Cruz/Soquel 93 63 0 0.00 2.24 0.00 (0.00, 5.14) Average

El Camino Hospital 114 85 1 1.18 2.36 0.98 (0.02, 5.47) Average

Good Samaritan Hospital – San Jose 97 71 3 4.23 2.29 3.63 (0.75, 10.60) Average


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Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG

Mortality





RAMR Performance

Rating*

State 15,715 12,152 239 1.97

San Francisco Bay Area & San Jose (continued)

John Muir Medical Center – Concord Campus 255 206 1 0.49 2.09 0.46 (0.01, 2.55) Average

Kaiser Foundation Hospital – San Francisco 374 305 3 0.98 1.28 1.51 (0.31, 4.40) Average

Kaiser Foundation Hospital – Santa Clara 353 263 6 2.28 2.11 2.12 (0.78, 4.62) Average

Marin General Hospital 41 32 0 0.00 1.49 0.00 (0.00, 15.25) Average

North Bay Medical Center 35 35 1 2.86 2.44 2.31 (0.06, 12.85) Average

O’Connor Hospital – San Jose 48 40 1 2.50 2.51 1.96 (0.05, 11.20) Average

Peninsula Medical Center 61 46 0 0.00 1.45 0.00 (0.00, 10.84) Average

Queen of the Valley Hospital – Napa 45 36 1 2.78 2.06 2.65 (0.07, 14.77) Average

Regional Medical of San Jose 82 66 0 0.00 2.25 0.00 (0.00, 4.88) Average

Salinas Valley Memorial Hospital 116 103 0 0.00 2.12 0.00 (0.00, 3.31) Average

San Ramon Regional Medical Center 27 24 0 0.00 2.52 0.00 (0.00, 12.01) Average

Santa Clara Valley Medical Center 87 69 1 1.45 1.55 1.84 (0.05, 10.25) Average

Santa Rosa Memorial Hospital – Montgomery 84 71 0 0.00 1.82 0.00 (0.00, 5.63) Average

Sequoia Hospital 94 55 2 3.64 2.49 2.88 (0.35, 10.39) Average

Seton Medical Center 57 51 2 3.92 2.69 2.87 (0.35, 10.36) Average

St. Helena Hospital 106 82 0 0.00 1.34 0.00 (0.00, 6.62) Average


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Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG

Mortality





RAMR Performance

Rating*

State 15,715 12,152 239 1.97


St. Mary’s Medical Center, San Francisco 23 22 0 0.00 2.20 0.00 (0.00, 15.00) Average

Stanford Hospital 145 97 1 1.03 2.37 0.86 (0.02, 4.77) Average

Sutter Santa Rosa Regional Hospital 65 52 0 0.00 1.27 0.00 (0.00, 10.96) Average

UC San Francisco Medical Center 79 66 0 0.00 1.50 0.00 (0.00, 7.32) Average

Valleycare Medical Center 31 25 0 0.00 2.47 0.00 (0.00, 11.77) Average

Washington Hospital – Fremont 100 86 0 0.00 1.76 0.00 (0.00, 4.80) Average

Central California

Bakersfield Heart Hospital 57 50 1 2.00 1.85 2.13 (0.05, 11.85) Average

Bakersfield Memorial Hospital 142 119 2 1.68 1.84 1.80 (0.22, 6.49) Average

Community Regional Medical Center – Fresno 257 220 13 5.91 2.37 4.91 (2.61, 8.39) Worse

Dameron Hospital 63 57 3 5.26 2.08 4.97 (1.03, 14.53) Average

Doctors Medical Center 306 244 6 2.46 2.67 1.81 (0.66, 3.94) Average

Emanuel Medical Center 80 73 2 2.74 2.11 2.56 (0.31, 9.24) Average

Fresno Heart and Surgical Hospital 171 139 1 0.72 2.29 0.62 (0.02, 3.44) Average

Kaweah Delta Medical Center 183 166 3 1.81 2.07 1.72 (0.35, 5.01) Average

Marian Regional Medical Center 73 59 2 3.39 2.56 2.60 (0.32, 9.40) Average

Memorial Hospital Medical Center – Modesto 203 151 3 1.99 2.50 1.57 (0.32, 4.58) Average


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Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG

Mortality





RAMR Performance

Rating*

State 15,715 12,152 239 1.97

Central California (continued)

Saint Agnes Medical Center 293 235 4 1.70 1.92 1.75 (0.48, 4.47) Average

San Joaquin Community Hospital 89 74 3 4.05 2.42 3.30 (0.68, 9.63) Average

St. Joseph’s Medical Center of Stockton 274 225 7 3.11 2.74 2.23 (0.90, 4.60) Average

San Fernando Valley, Antelope Valley, Ventura & Santa Barbara

Antelope Valley Hospital 19 17 1 5.88 2.09 5.55 (0.14, 30.90) Average

Community Memorial Hospital – San Buenaventura 99 75 1 1.33 1.64 1.60 (0.04, 8.91) Average

French Hospital Medical Center 107 77 1 1.30 1.25 2.04 (0.05, 11.38) Average

Glendale Adventist Medical Center – Wilson Terrace 122 96 5 5.21 1.72 5.96 (1.94, 13.92) Average

Glendale Memorial Hospital and Medical Center 140 120 0 0.00 1.51 0.00 (0.00, 4.00) Average

Los Robles Hospital and Medical Center 84 65 6 9.23 4.46 4.07 (1.49, 8.86) Average

Northridge Hospital Medical Center 94 85 2 2.35 2.08 2.23 (0.27, 8.05) Average

Palmdale Regional Medical Center 8 8 1 12.50 1.46 16.88 (0.43, 94.06) Average

Providence Holy Cross Medical Center 52 39 2 5.13 1.73 5.85 (0.71, 21.12) Average

Providence Saint Joseph Medical Center 62 46 0 0.00 1.35 0.00 (0.00, 11.65) Average

Providence Tarzana Medical Center 70 62 3 4.84 2.14 4.45 (0.92, 13.02) Average


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Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG

Mortality





RAMR Performance

Rating*

State 15,715 12,152 239 1.97

San Fernando Valley, Antelope Valley, Ventura & Santa Barbara (continued)

Santa Barbara Cottage Hospital 111 90 3 3.33 1.69 3.89 (0.80, 11.35) Average

St. John’s Regional Medical Center 99 83 2 2.41 2.15 2.20 (0.27, 7.95) Average

Valley Presbyterian Hospital 44 42 0 0.00 1.36 0.00 (0.00, 12.68) Average

West Hills Hospital and Medical Center 58 51 2 3.92 3.11 2.48 (0.30, 8.95) Average

Greater Los Angeles

Beverly Hospital 14 13 0 0.00 1.62 0.00 (0.00, 34.40) Average

California Hospital Medical Center – Los Angeles 28 19 0 0.00 3.65 0.00 (0.00, 10.46) Average

Cedars Sinai Medical Center 194 129 0 0.00 1.63 0.00 (0.00, 3.44) Average

Centinela Hospital Medical Center 33 28 3 10.71 2.34 8.99 (1.85, 26.27) Average

Citrus Valley Medical Center – Inter Community Campus 128 110 3 2.73 2.75 1.95 (0.40, 5.70) Average

Downey Regional Medical Center 49 46 0 0.00 1.90 0.00 (0.00, 8.29) Average

Garfield Medical Center 121 102 1 0.98 2.02 0.95 (0.02, 5.31) Average

Good Samaritan Hospital – Los Angeles 103 87 2 2.30 2.04 2.22 (0.27, 8.02) Average

Henry Mayo Newhall Memorial Hospital 43 35 1 2.86 2.62 2.14 (0.05, 11.94) Average

Hollywood Presbyterian Medical Center 44 42 1 2.38 1.69 2.78 (0.07, 15.46) Average

Huntington Memorial Hospital 95 65 0 0.00 1.67 0.00 (0.00, 6.67) Average


13

Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG

Mortality





RAMR Performance

Rating*

State 15,715 12,152 239 1.97

Greater Los Angeles (continued)

Kaiser Foundation Hospital – Sunset 769 583 7 1.20 1.95 1.21 (0.49, 2.50) Average

Keck Hospital of University of Southern California 147 73 4 5.48 2.26 4.76 (1.30, 12.19) Average

Lakewood Regional Medical Center 110 89 3 3.37 2.99 2.22 (0.46, 6.48) Average

Long Beach Memorial Medical Center 183 159 4 2.52 2.32 2.13 (0.58, 5.45) Average

Los Angeles County/Harbor – UCLA Medical Center 74 64 0 0.00 1.89 0.00 (0.00, 6.00) Average

Los Angeles County/University of Southern California Medical Center

101 80 1 1.25 0.93 2.64 (0.07, 14.68) Average

Methodist Hospital of Southern California 66 54 4 7.41 2.45 5.94 (1.62, 15.22) Average

Presbyterian Intercommunity Hospital 111 51 2 3.92 1.80 4.29 (0.52, 15.48) Average

Providence Little Company of Mary Medical Center – Torrance

130 92 3 3.26 2.80 2.29 (0.47, 6.69) Average

Ronald Reagan UCLA Medical Center 231 137 6 4.38 1.92 4.48 (1.64, 9.74) Average

Saint John’s Health Center 53 41 2 4.88 1.87 5.14 (0.62, 18.58) Average

St. Francis Medical Center 34 28 1 3.57 1.29 5.45 (0.14, 30.36) Average

St. Mary Medical Center – Long Beach 43 36 0 0.00 2.61 0.00 (0.00, 7.73) Average


14

Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG

Mortality





RAMR Performance

Rating*

State 15,715 12,152 239 1.97


St. Vincent Medical Center 55 48 1 2.08 1.70 2.41 (0.06, 13.43) Average

Torrance Memorial Medical Center 73 47 0 0.00 1.33 0.00 (0.00, 11.62) Average

White Memorial Medical Center 47 39 2 5.13 1.46 6.93 (0.84, 25.03) Average

Inland Empire, Riverside & San Bernardino

Desert Regional Medical Center 138 112 7 6.25 1.59 7.72 (3.11, 15.91) Worse

Desert Valley Hospital 39 34 3 8.82 1.90 9.14 (1.88, 26.70) Average

Eisenhower Medical Center 152 122 0 0.00 2.75 0.00 (0.00, 2.17) Average

Kaiser Foundation Hospital – Fontana 61 51 0 0.00 1.80 0.00 (0.00, 7.90) Average

Loma Linda University Medical Center 211 161 8 4.97 2.82 3.47 (1.50, 6.84) Average

Loma Linda University Medical Center – Murrieta 124 115 1 0.87 2.21 0.77 (0.02, 4.31) Average

Pomona Valley Hospital Medical Center 153 131 0 0.00 1.75 0.00 (0.00, 3.17) Average

Riverside Community Hospital 195 162 2 1.23 1.87 1.30 (0.16, 4.68) Average

San Antonio Community Hospital 181 130 6 4.62 2.06 4.40 (1.61, 9.57) Average

St. Bernardine Medical Center 503 429 3 0.70 1.78 0.77 (0.16, 2.26) Average

St. Mary Medical Center – Apple Valley 106 80 0 0.00 1.17 0.00 (0.00, 7.74) Average

Temecula Valley Hospital 16 15 0 0.00 1.71 0.00 (0.00, 28.25) Average


15

Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG

Mortality





RAMR Performance

Rating*

State 15,715 12,152 239 1.97

Orange County

AHMC Anaheim Regional Medical Center 160 129 0 0.00 1.83 0.00 (0.00, 3.07) Average

Fountain Valley Regional Hospital and Medical Center – Euclid

123 118 5 4.24 2.39 3.49 (1.13, 8.15) Average

Hoag Memorial Hospital Presbyterian 208 135 0 0.00 1.71 0.00 (0.00, 3.14) Average

Mission Hospital Regional Medical Center 148 113 2 1.77 2.45 1.42 (0.17, 5.13) Average

Orange Coast Memorial Medical Center 74 59 0 0.00 1.44 0.00 (0.00, 8.52) Average

Saddleback Memorial Medical Center 84 67 0 0.00 1.72 0.00 (0.00, 6.29) Average

St. Joseph Hospital – Orange 130 61 3 4.92 2.25 4.31 (0.89, 12.58) Average

St. Jude Medical Center 101 79 0 0.00 1.45 0.00 (0.00, 6.33) Average

UC Irvine Medical Center 81 71 4 5.63 2.54 4.36 (1.19, 11.16) Average

West Anaheim Medical Center 23 22 0 0.00 1.46 0.00 (0.00, 22.60) Average

Western Medical Center – Anaheim 34 30 2 6.67 2.37 5.52 (0.67, 19.95) Average

Western Medical Center – Santa Ana 93 82 1 1.22 2.64 0.91 (0.02, 5.06) Average

Greater San Diego

Alvarado Hospital 36 28 1 3.57 2.24 3.14 (0.08, 17.50) Average

Grossmont Hospital 150 115 3 2.61 2.35 2.18 (0.45, 6.38) Average

Palomar Health Downtown Campus 59 44 0 0.00 1.58 0.00 (0.00, 10.46) Average


16

Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG

Mortality





RAMR Performance

Rating*

State 15,715 12,152 239 1.97

Greater San Diego (continued)

Scripps Green Hospital 81 49 0 0.00 0.98 0.00 (0.00, 15.06) Average

Scripps Memorial Hospital – La Jolla 368 249 3 1.20 2.01 1.18 (0.24, 3.44) Average

Scripps Mercy Hospital 118 99 4 4.04 2.32 3.42 (0.93, 8.77) Average

Sharp Chula Vista Medical Center 110 84 0 0.00 2.34 0.00 (0.00, 3.69) Average

Sharp Memorial Hospital† 181 107 2 1.87 1.46 2.52 (0.30, 9.10) Average

Tri-City Medical Center – Oceanside 99 89 2 2.25 2.40 1.84 (0.22, 6.65) Average

UC San Diego Health – Sulpizio Cardiovascular Center

146 89 1 1.12 1.61 1.37 (0.03, 7.63) Average

*A hospital is classified as “Better” if the upper 95% CI of the RAMR falls below the California observed mortality rate (1.97%). A hospital is classified as “Worse” if the lower 95% CI of the RAMR is higher than the California observed mortality rate. A hospital’s performance is considered “Average” if the California mortality rate falls within the 95% CI of a hospital’s RAMR.

† Hospitals submitted statements regarding this report. See Appendix C for their statements.


17

Surgeon Risk-Adjusted Operative Mortality Results for Isolated CABG, 2013-2014 Among the 24,092 isolated and non-salvage CABG surgeries performed in 2013 and 2014, 512 patients died either in-hospital or within 30 days of the surgery date, reflecting a statewide operative mortality rate of 2.13%. The observed mortality rates among surgeons overall ranged from 0% to 100.00%. The expected mortality rates, which are generated by the risk model and account for patient severity of illness, ranged from 0.35% and 16.26%. The risk-adjusted mortality rates (RAMR) ranged from 0% to 100.00%. Based on the 95% confidence intervals for the risk-adjusted mortality rates, 264 of 271 surgeons (97%) performed within the expected range when compared to the statewide mortality rate. Three surgeons performed significantly “Better” than the state average, and six surgeons performed significantly “Worse” than the state average (Table C-4).


18

Table C-4: Surgeon Risk-Adjusted Mortality Results, 2013-2014

Surgeon Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG Deaths

Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Abolhoda, Amir M. Surgeon Overall 24 18 0 0.00 2.46 0.00 (0.00, 17.71) Average

Lakewood Regional Medical Center 2 1 0 0.00 1.69 0.00 (0.00,

100.00) Average

Long Beach Memorial Medical Center 22 17 0 0.00 2.50 0.00 (0.00,

18.41) Average

Abraham, Reginald G. Surgeon Overall 51 45 3 6.67 1.78 7.95 (1.64, 23.22) Average


51 45 3 6.67 1.78 7.95 (1.64, 23.22) Average

Adamson, Robert M. Surgeon Overall 118 72 0 0.00 1.33 0.00 (0.00, 8.16) Average

Sharp Memorial Hospital 118 72 0 0.00 1.33 0.00 (0.00,

8.16) Average

Afifi, Alaa Y. Surgeon Overall 77 75 3 4.00 2.44 3.49 (0.72, 10.19) Average

AHMC Anaheim Regional Medical Center

7 6 0 0.00 1.47 0.00 (0.00, 89.06) Average


41 41 1 2.44 2.94 1.76 (0.04, 9.83) Average

West Anaheim Medical Center 2 2 0 0.00 1.00 0.00 (0.00,

100.00) Average


19


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Afifi, Alaa Y. (continued)

Western Medical Center – Santa Ana 1 1 0 0.00 1.71 0.00 (0.00,

100.00) Average

Western Medical Center Hospital – Anaheim

26 25 2 8.00 2.00 8.51 (1.03, 30.73) Average

Al–Dossari, Ghannam A. Surgeon Overall 18 17 0 0.00 1.80 0.00 (0.00, 25.58) Average

UCSF Medical Center 18 17 0 0.00 1.80 0.00 (0.00, 25.58) Average

Allen, Jeremiah G. Surgeon Overall 33 32 1 3.13 1.05 6.32 (0.16, 35.23) Average

Kaiser Foundation Hospital – San Francisco

33 32 1 3.13 1.05 6.32 (0.16, 35.23) Average

Alyono, David Surgeon Overall 167 132 2 1.52 1.78 1.81 (0.22, 6.53) Average

Kaiser Foundation Hospital – Santa Clara 167 132 2 1.52 1.78 1.81 (0.22,

6.53) Average

Anastassiou, Peter T. Surgeon Overall 17 15 0 0.00 1.48 0.00 (0.00, 35.29) Average


Sutter Medical Center of Santa Rosa 16 14 0 0.00 1.54 0.00 (0.00,

36.40) Average

Arabia, Francisco A. Surgeon Overall 14 9 0 0.00 1.24 0.00 (0.00, 70.51) Average


20


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Arabia, Francisco A. (continued)

Cedars Sinai Medical Center 14 9 0 0.00 1.24 0.00 (0.00,

70.51) Average

Araim, Leheb H. Surgeon Overall 194 174 3 1.72 1.87 1.96 (0.40, 5.73) Average

Kaweah Delta Medical Center 194 174 3 1.72 1.87 1.96 (0.40,

5.73) Average

Ardehali, Abbas Surgeon Overall 161 97 3 3.09 2.12 3.09 (0.64, 9.04) Average

Ronald Reagan UCLA Medical Center 161 97 3 3.09 2.12 3.09 (0.64,

9.04) Average

Atiya, Azmi W. Surgeon Overall 158 135 6 4.44 2.55 3.71 (1.36, 8.07) Average

Henry Mayo Newhall Memorial Hospital 4 4 1 25.00 4.47 11.88 (0.30,

66.17) Average

Northridge Hospital Medical Center 106 93 2 2.15 2.48 1.84 (0.22,

6.64) Average

Providence Holy Cross Medical Center 16 12 1 8.33 1.59 11.12 (0.28,

61.97) Average

Providence Tarzana Medical Center 23 18 1 5.56 2.62 4.51 (0.11,

25.12) Average

Valley Presbyterian Hospital 3 2 1 50.00 1.26 84.33 (2.14,

100.00) Worse

West Hills Regional Medical Center 6 6 0 0.00 4.36 0.00 (0.00,

29.98) Average

Atkins, Broadus Z. Surgeon Overall 123 81 2 2.47 2.51 2.09 (0.25, 7.57) Average


21


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Atkins, Broadus Z. (continued)

UC Davis Medical Center 123 81 2 2.47 2.51 2.09 (0.25,

7.57) Average

Badduke, Brian R. Surgeon Overall 98 92 2 2.17 2.93 1.58 (0.19, 5.69) Average

Washington Hospital – Fremont 98 92 2 2.17 2.93 1.58 (0.19,

5.69) Average

Baker, Craig J. Surgeon Overall 120 69 2 2.90 1.78 3.47 (0.42, 12.53) Average

Huntington Memorial Hospital 14 8 0 0.00 1.35 0.00 (0.00,

72.42) Average

Keck Hospital of USC 80 44 2 4.55 2.09 4.62 (0.56, 16.69) Average


26 17 0 0.00 1.16 0.00 (0.00, 39.86) Average

Baladi, Naoum Surgeon Overall 85 73 2 2.74 3.18 1.83 (0.22, 6.60) Average


St. Mary's Medical Center, San Francisco 14 12 0 0.00 2.98 0.00 (0.00,

21.93) Average

Baradarian, Sam Surgeon Overall 177 119 0 0.00 1.77 0.00 (0.00, 3.73) Average

Scripps Green Hospital 1 1 0 0.00 4.52 0.00 (0.00,

100.00) Average


22


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Baradarian, Sam (continued)

Scripps Memorial Hospital – La Jolla 176 118 0 0.00 1.74 0.00 (0.00,

3.81) Average

Bastidas, Juan G. Surgeon Overall 17 16 0 0.00 1.34 0.00 (0.00, 36.59) Average

Loma Linda Murrieta 17 16 0 0.00 1.34 0.00 (0.00, 36.59) Average

Baumgartner, Fritz J. Surgeon Overall 12 11 0 0.00 2.69 0.00 (0.00, 26.51) Average

Enloe Medical Center – Esplanade Campus 4 4 0 0.00 1.89 0.00 (0.00,

100.00) Average


100.00) Average

Mercy Medical Center – Redding 7 6 0 0.00 3.57 0.00 (0.00,

36.58) Average

Benharash, Peyman Surgeon Overall 25 20 2 10.00 1.58 13.43 (1.63, 48.52) Average


48.52) Average

Bethencourt, Daniel M. Surgeon Overall 189 151 5 3.31 1.95 3.60 (1.17, 8.41) Average


9.79) Average

Orange Coast Memorial Medical Center

45 34 0 0.00 1.22 0.00 (0.00, 18.94) Average

Beygui, Ramin E. Surgeon Overall 53 44 0 0.00 2.02 0.00 (0.00, 8.81) Average


23


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Beygui, Ramin E. (continued)

North Bay Medical Center 15 15 0 0.00 2.13 0.00 (0.00,

24.49) Average


Birnbaum, Peter L. Surgeon Overall 167 113 2 1.77 1.35 2.77 (0.34, 10.03) Average

Community Regional Medical Center – Fresno

8 5 1 20.00 3.11 13.66 (0.35, 76.13) Average

Fresno Heart and Surgical Hospital 22 16 0 0.00 1.43 0.00 (0.00,

34.18) Average

Saint Agnes Medical Center 137 92 1 1.09 1.25 1.85 (0.05,

10.33) Average

Biswas, Shankha S. Surgeon Overall 143 112 3 2.68 2.30 2.47 (0.51, 7.23) Average


Riverside Community Hospital 111 88 2 2.27 2.17 2.23 (0.27,

8.06) Average

San Antonio Community Hospital 31 23 1 4.35 2.88 3.21 (0.08,

17.89) Average

Bowdish, Michael E. Surgeon Overall 78 65 1 1.54 1.40 2.33 (0.06, 12.97) Average


89.16)

Average


24


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Bowdish, Michael E. (continued) Keck Hospital of USC 14 8 0 0.00 3.86 0.00 (0.00,

25.42) Average


60 53 1 1.89 0.98 4.11 (0.10, 22.91) Average

Boyd, Jack H. Surgeon Overall 17 15 0 0.00 1.81 0.00 (0.00, 28.90) Average


Boyd, Walter D. Surgeon Overall 71 60 2 3.33 1.79 3.96 (0.48, 14.30) Average


14.30) Average

Brewster, Scot A. Surgeon Overall 118 72 0 0.00 1.71 0.00 (0.00, 6.38) Average


6.38) Average

Burdon, Thomas A. Surgeon Overall 1 1 0 0.00 0.61 0.00 (0.00, 100.00) Average


Bushnell, Lamar J. Surgeon Overall 70 52 1 1.92 1.66 2.46 (0.06, 13.68) Average

Community Memorial Hospital – San Buenaventura

70 52 1 1.92 1.66 2.46 (0.06, 13.68) Average


25


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Caffarelli, Anthony D. Surgeon Overall 181 118 2 1.69 2.06 1.75 (0.21, 6.31) Average

Hoag Memorial Hospital Presbyterian 181 118 2 1.69 2.06 1.75 (0.21,

6.31) Average

Cain, Brian S. Surgeon Overall 225 193 2 1.04 1.56 1.41 (0.17, 5.11) Average


225 193 2 1.04 1.56 1.41 (0.17, 5.11) Average

Cambronero, Neil F. Surgeon Overall 2 1 0 0.00 1.80 0.00 (0.00, 100.00) Average


Caminha, Sergio D. Surgeon Overall 170 150 3 2.00 2.25 1.89 (0.39, 5.52) Average


5.52) Average

Canvasser, David A. Surgeon Overall 148 111 3 2.70 2.03 2.83 (0.58, 8.27) Average

French Hospital Medical Center 96 69 2 2.90 1.45 4.26 (0.52,

15.39) Average

Marian Medical Center 52 42 1 2.38 2.99 1.69 (0.04, 9.44) Average

Capouya, Eli R. Surgeon Overall 239 189 9 4.76 1.84 5.51 (2.52, 10.46) Worse

Citrus Valley Medical Center IC Campus 40 35 0 0.00 1.65 0.00 (0.00,

13.54) Average


26


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Capouya, Eli R. (continued)

Glendale Adventist Medical Center – Wilson Terrace

87 65 3 4.62 1.66 5.89 (1.22, 17.22) Average

Good Samaritan Hospital – Los Angeles 37 33 2 6.06 2.53 5.08 (0.62,

18.36) Average


100.00) Average

Methodist Hospital of Southern California 60 45 4 8.89 1.67 11.34 (3.09,

29.05) Worse

Providence Saint Joseph Medical Center 6 4 0 0.00 1.50 0.00 (0.00,

100.00) Average

St. Vincent Medical Center 3 3 0 0.00 3.56 0.00 (0.00,

73.41) Average

Castro, Luis J. Surgeon Overall 152 83 3 3.61 2.37 3.24 (0.67, 9.47) Average


Chammas, Joseph H. Surgeon Overall 86 72 3 4.17 1.47 6.03 (1.24, 17.62) Average


17.62) Average

Chaudhry, Pervaiz A. Surgeon Overall 328 269 6 2.23 2.15 2.21 (0.81, 4.80) Average


281 226 6 2.65 2.23 2.53 (0.93, 5.52) Average


27


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Chaudhry, Pervaiz A. (continued)


41.35) Average


13.98) Average

Chen, Raymond H. Surgeon Overall 189 150 3 2.00 1.71 2.48 (0.51, 7.26) Average

Kaiser Foundation Hospital – Sunset 189 150 3 2.00 1.71 2.48 (0.51,

7.26) Average

Cheng, Wen Surgeon Overall 3 3 0 0.00 1.35 0.00 (0.00, 100.00) Average


100.00) Average

Chow, Michael I. Surgeon Overall 214 160 2 1.25 1.50 1.77 (0.21, 6.40) Average

Mercy General Hospital 214 160 2 1.25 1.50 1.77 (0.21,

6.40) Average

Cohen, Robbin G. Surgeon Overall 154 104 0 0.00 1.91 0.00 (0.00, 3.94) Average


3.96) Average

Keck Hospital of USC 3 N/A N/A N/A N/A N/A NA N/A


1 1 0 0.00 1.16 0.00 (0.00, 100.00) Average

Cohler, Larry F. Surgeon Overall 77 72 5 6.94 2.58 5.73 (1.86, 13.38) Average


28


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Cohler, Larry F. (continued) Community Regional Medical Center – Fresno

69 64 5 7.81 2.55 6.52 (2.12, 15.22) Average


84.56) Average


59.36) Average

Coletta, Joelle M. Surgeon Overall 3 1 1 100.00 7.56 28.10 (0.71, 100.00) Average


3 1 1 100.00 7.56 28.10 (0.71, 100.00) Average

Concepcion, Noel L. Surgeon Overall 251 195 4 2.05 2.34 1.86 (0.51, 4.76) Average

Doctors Medical Center 197 146 4 2.74 2.52 2.31 (0.63,

5.93) Average

Emanuel Medical Center 42 39 0 0.00 1.84 0.00 (0.00,

10.92) Average

Memorial Hospital Medical Center – Modesto

12 10 0 0.00 1.79 0.00 (0.00, 43.80) Average

Copeland, Jack G. Surgeon Overall 2 2 0 0.00 6.95 0.00 (0.00, 56.42) Average


2 2 0 0.00 6.95 0.00 (0.00, 56.42) Average

Cummings, Steven P. Surgeon Overall 109 96 3 3.13 1.78 3.74 (0.77, 10.92) Average


29


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Cummings, Steven P. (continued)


48.96) Average


10.48) Average

Cunningham, Mark J. Surgeon Overall 80 38 1 2.63 2.18 2.56 (0.06, 14.29) Average


100.00) Average



6 4 0 0.00 1.40 0.00 (0.00, 100.00) Average

Daniel, Subashini R. Surgeon Overall 15 14 0 0.00 2.99 0.00 (0.00, 18.73) Average

Salinas Valley Memorial Hospital 15 14 0 0.00 2.99 0.00 (0.00,

18.73) Average

Danielson, Daren S. Surgeon Overall 132 114 1 0.88 2.07 0.90 (0.02, 5.03) Average

Sutter Memorial Hospital 132 114 1 0.88 2.07 0.90 (0.02,

5.03) Average

Darbinian, Sevak H. Surgeon Overall 210 151 1 0.66 1.92 0.73 (0.02, 4.08) Average

Mission Hospital Regional Medical Center

193 139 1 0.72 1.94 0.79 (0.02, 4.39) Average


30


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Darbinian, Sevak H. (continued)

Saddleback Memorial Medical Center 17 12 0 0.00 1.65 0.00 (0.00,

39.49) Average

Davtyan, Hakob G. Surgeon Overall 281 220 7 3.18 1.67 4.06 (1.63, 8.35) Average


14.71) Average

St. Bernardine Medical Center 117 98 4 4.08 1.80 4.83 (1.31,

12.35) Average

St. Mary Medical Center – Apple Valley 57 46 0 0.00 1.39 0.00 (0.00,

12.25) Average

Declusin, Richard J. Surgeon Overall 105 79 2 2.53 2.16 2.49 (0.30, 8.98) Average


2 1 0 0.00 0.65 0.00 (0.00, 100.00) Average

Los Robles Hospital & Medical Center 2 1 0 0.00 2.40 0.00 (0.00,

100.00) Average

St. John's Regional Medical Center 101 77 2 2.60 2.18 2.53 (0.31,

9.14) Average

Deeik, Ramzi K. Surgeon Overall 129 105 2 1.90 2.53 1.60 (0.19, 5.79) Average


22.32) Average

Queen of the Valley Hospital – Napa 2 2 0 0.00 1.01 0.00 (0.00,

100.00) Average


31


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Deeik, Ramzi K. (continued)

Santa Rosa Memorial Hospital – Montgomery

113 89 2 2.25 2.56 1.86 (0.23, 6.73) Average

Defilippi, Vincent J. Surgeon Overall 191 167 4 2.40 1.96 2.59 (0.71, 6.64) Average


6.64) Average

Dein, John R. Surgeon Overall 185 152 2 1.32 1.60 1.75 (0.21, 6.33) Average


7.12) Average

Mercy San Juan Hospital 16 15 0 0.00 1.80 0.00 (0.00,

29.04) Average

Delrio, Michael J. Surgeon Overall 28 23 0 0.00 1.80 0.00 (0.00, 18.96) Average


Palomar Medical Center 2 2 0 0.00 1.14 0.00 (0.00,

100.00) Average


20.48) Average

Dembitsky, Walter P. Surgeon Overall 104 47 1 2.13 1.90 2.38 (0.06, 13.25) Average


13.25) Average

Dhar, Naveen Surgeon Overall 23 20 0 0.00 1.83 0.00 (0.00, 21.37) Average


32


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Dhar, Naveen (continued) Fountain Valley Regional Hospital and Medical Center – Euclid

18 15 0 0.00 1.93 0.00 (0.00, 27.12) Average


100.00) Average

Dharan, Murali Surgeon Overall 158 127 0 0.00 1.85 0.00 (0.00, 3.34) Average

John Muir Medical Center – Concord Campus

95 79 0 0.00 1.70 0.00 (0.00, 5.84) Average

San Ramon Regional Medical Center 29 24 0 0.00 2.40 0.00 (0.00,

13.62) Average

Valleycare Medical Center 34 24 0 0.00 1.79 0.00 (0.00,

18.26) Average

Dhawan, Puneet Surgeon Overall 162 127 3 2.36 1.75 2.87 (0.59, 8.40) Average

Los Angeles County/Harbor – UCLA Medical Center

81 67 3 4.48 1.60 5.96 (1.23, 17.41) Average

St. Jude Medical Center 81 60 0 0.00 1.91 0.00 (0.00,

6.83) Average

Dhillon, Jatinder S. Surgeon Overall 114 97 0 0.00 3.03 0.00 (0.00, 2.67) Average


97 83 0 0.00 2.88 0.00 (0.00, 3.28) Average


33


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Dhillon, Jatinder S. (contined)


100.00) Average


15.97) Average

Dunnington, Gansevoort H. Surgeon Overall 100 72 0 0.00 1.59 0.00 (0.00, 6.84) Average


84.96) Average


100.00) Average


Durzinsky, Dennis S. Surgeon Overall 1 1 0 0.00 0.39 0.00 (0.00, 100.00) Average


1 1 0 0.00 0.39 0.00 (0.00, 100.00) Average

Egrie, Glenn D. Surgeon Overall 111 90 2 2.22 1.95 2.42 (0.29, 8.74) Average

California Pacific Med Center – Pacific Campus

111 90 2 2.22 1.95 2.42 (0.29, 8.74) Average

Ehrman, Walter J. Surgeon Overall 24 23 1 4.35 1.17 7.88 (0.20, 43.93) Average

Desert Regional Medical Center 24 23 1 4.35 1.17 7.88 (0.20,

43.93) Average


34


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Ellis, Robert J. Surgeon Overall 18 18 0 0.00 1.27 0.00 (0.00, 34.32) Average


Esmailian, Fardad Surgeon Overall 153 118 1 0.85 1.99 0.90 (0.02, 5.03) Average


5.03) Average

Faber, Luke A. Surgeon Overall 121 88 0 0.00 1.51 0.00 (0.00, 5.91) Average


9.25) Average


Faraci, Philip A. Surgeon Overall 49 33 4 12.12 3.09 8.34 (2.27, 21.35) Worse


100.00) Average


56.54) Average


23.04) Average

Felahy, Isam Surgeon Overall 84 74 1 1.35 2.28 1.26 (0.03, 7.03) Average



35


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Felahy, Isam (continued)

St. Joseph's Medical Center of Stockton 61 53 1 1.89 2.58 1.55 (0.04,

8.64) Average

Fischbein, Michael P. Surgeon Overall 65 42 0 0.00 1.94 0.00 (0.00, 9.64) Average


Fleischman, Fernando Surgeon Overall 113 83 2 2.41 1.46 3.50 (0.42, 12.64) Average


100.00) Average

Keck Hospital of USC 11 8 2 25.00 2.62 20.30 (2.46, 73.32) Worse


98 71 0 0.00 1.36 0.00 (0.00, 8.10) Average

Flores, Mona G. Surgeon Overall 23 18 1 5.56 1.29 9.13 (0.23, 50.85) Average


50.85) Average

Floridia, Rosario Surgeon Overall 138 113 6 5.31 3.15 3.58 (1.31, 7.79) Average


Loma Linda University Medical Center 130 106 6 5.66 3.23 3.72 (1.36,

8.09) Average


36


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Folkerth, Theodore L. Surgeon Overall 119 98 4 4.08 2.46 3.53 (0.96, 9.03) Average

Palomar Medical Center 1 N/A N/A N/A N/A N/A (N/A,

N/A) N/A

Tri-City Medical Center 118 98 4 4.08 2.46 3.53 (0.96, 9.03) Average

Freyaldenhoven, Stephen J. Surgeon Overall 99 77 1 1.30 2.18 1.27 (0.03, 7.05) Average


12.15) Average


Fung, Lit K. Surgeon Overall 315 240 6 2.50 2.35 2.26 (0.83, 4.91) Average


100.00) Average


314 239 6 2.51 2.36 2.26 (0.83, 4.92) Average

Gao, Guangqiang Surgeon Overall 116 105 1 0.95 1.96 1.03 (0.03, 5.77) Average



19.16) Average


57.38) Average


37


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Gao, Guangqiang (continued)

Garfield Medical Center 59 52 0 0.00 2.02 0.00 (0.00,

7.46) Average

Gates, Richard N. Surgeon Overall 83 54 1 1.85 1.35 2.91 (0.07, 16.19) Average


100.00) Average

St. Joseph Hospital – Orange 82 53 1 1.89 1.37 2.92 (0.07,

16.29) Average

Gaudiani, Vincent A. Surgeon Overall 85 42 1 2.38 2.02 2.50 (0.06, 13.95) Average


16 8 0 0.00 1.46 0.00 (0.00, 67.29) Average

Community Hospital Monterey Peninsula 38 19 1 5.26 1.78 6.29 (0.16,

35.03) Average


Peninsula Medical Center 2 1 0 0.00 0.53 0.00 (0.00,

100.00) Average

Ghaly, Aziz S. Surgeon Overall 47 37 1 2.70 2.38 2.41 (0.06, 13.43) Average



20.06) Average

Gharai, Fariba Surgeon Overall 40 34 0 0.00 1.23 0.00 (0.00, 18.73) Average


38


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Gharai, Fariba (continued)


18.73) Average

Gharavi, Mohammad A. Surgeon Overall 222 175 6 3.43 2.41 3.02 (1.11, 6.58) Average


7.08) Average


21.51) Average


10.01) Average

Gheissari, Ali Surgeon Overall 180 143 2 1.40 1.95 1.53 (0.19, 5.52) Average


48.22) Average


8 6 0 0.00 1.70 0.00 (0.00, 77.01) Average


7.69) Average


100.00) Average


100.00) Average


19.95) Average

Gibson, Christopher F. Surgeon Overall 309 249 6 2.41 1.75 2.92 (1.07, 6.36) Average


39


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Gibson, Christopher F. (continued)


13.59) Average


8.78) Average


11.76) Average

Golts, Eugene M. Surgeon Overall 145 99 1 1.01 1.43 1.50 (0.04, 8.36) Average

Temecula Valley Hospital 14 13 0 0.00 1.71 0.00 (0.00,

35.33) Average


131 86 1 1.16 1.39 1.78 (0.05, 9.91) Average

Gordon, Robert T. Surgeon Overall 190 145 2 1.38 1.53 1.91 (0.23, 6.90) Average


6.90) Average

Gottner, Robert J. Surgeon Overall 157 128 1 0.78 1.86 0.89 (0.02, 4.96) Average


38.81) Average


2 2 0 0.00 3.13 0.00 (0.00, 100.00) Average


12.47) Average


40


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Gottner, Robert J. (continued)


16.13) Average


8.73) Average


100.00) Average

Gramins, Daniel L. Surgeon Overall 1 1 0 0.00 0.54 0.00 (0.00, 100.00) Average


1 1 0 0.00 0.54 0.00 (0.00, 100.00) Average

Gregory, Richard D. Surgeon Overall 193 154 2 1.30 1.91 1.45 (0.18, 5.23) Average


81.55) Average


5.40) Average

Grewal, Navrose S. Surgeon Overall 125 114 1 0.88 2.92 0.64 (0.02, 3.56) Average

Downey Regional Medical Center 47 43 0 0.00 2.18 0.00 (0.00,

8.37) Average


6.87) Average


27.77) Average

Shasta Regional Medical Center 4 3 0 0.00 3.77 0.00 (0.00,

69.25) Average


41


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Grewal, Navrose S. (continued)

St. Mary Medical Center – Long Beach 10 9 0 0.00 2.34 0.00 (0.00,

37.25) Average

UC Irvine Medical Center 5 5 0 0.00 1.20 0.00 (0.00,

100.00) Average

Griffith, Patrick K. Surgeon Overall 111 88 5 5.68 2.51 4.81 (1.56, 11.23) Average

Rideout Memorial Hospital 111 88 5 5.68 2.51 4.81 (1.56,

11.23) Average

Gulati, Rajeev Surgeon Overall 95 83 1 1.20 2.41 1.06 (0.03, 5.92) Average

Pomona Valley Hospital Medical Center

90 79 1 1.27 2.45 1.10 (0.03, 6.13) Average


100.00) Average

Gundry, Steven R. Surgeon Overall 47 31 3 9.68 2.40 8.57 (1.77, 25.05) Average


25.05) Average

Ha, Richard–Tien V. Surgeon Overall 57 47 1 2.13 2.53 1.79 (0.05, 9.98) Average


54.99) Average

Santa Clara Valley Medical Center 14 12 0 0.00 1.14 0.00 (0.00,

57.26) Average



42


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Habibipour, Saied Surgeon Overall 195 162 5 3.09 1.67 3.94 (1.28, 9.19) Average


9.26) Average

Eisenhower Medical Center 1 1 0 0.00 1.87 0.00 (0.00,

100.00) Average

Hackmann, Amy E. Surgeon Overall 52 42 0 0.00 0.96 0.00 (0.00, 19.45) Average


92.52) Average



31 29 0 0.00 0.82 0.00 (0.00, 33.11) Average

Harmon, Adam L. Surgeon Overall 20 16 1 6.25 4.98 2.67 (0.07, 14.86) Average


Harper, Baron D. Surgeon Overall 86 77 4 5.19 2.30 4.80 (1.31, 12.28) Average

Rideout Memorial Hospital 86 77 4 5.19 2.30 4.80 (1.31,

12.28) Average

Hasaniya, Nahidh W. Surgeon Overall 137 111 3 2.70 2.44 2.36 (0.49, 6.88) Average


43


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Hasaniya, Nahidh W. (continued) Loma Linda Murrieta 119 93 2 2.15 2.48 1.85 (0.22,

6.67) Average


29.30) Average

Hemp, James R. Surgeon Overall 141 104 1 0.96 2.02 1.01 (0.03, 5.63) Average


100.00) Average


Hill, Arthur C. Surgeon Overall 30 26 0 0.00 1.09 0.00 (0.00, 27.79) Average


Hodgins, Darren M. Surgeon Overall 74 65 2 3.08 1.72 3.80 (0.46, 13.72) Average


9 6 1 16.67 1.00 35.58 (0.90, 100.00) Average

White Memorial Medical Center 65 59 1 1.69 1.80 2.01 (0.05,

11.17) Average

Hood, James S. Surgeon Overall 144 111 1 0.90 1.39 1.38 (0.03, 7.67) Average


144 111 1 0.90 1.39 1.38 (0.03, 7.67) Average


44


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Horan, Siobain M. Surgeon Overall 10 9 1 11.11 1.64 14.40 (0.36, 80.21) Average


80.21) Average

Howden, Frederick M. Surgeon Overall 49 30 0 0.00 1.77 0.00 (0.00, 14.77) Average



Palomar Medical Center 1 N/A N/A N/A N/A N/A (N/A,

N/A) N/A

Sharp Chula Vista Medical Center 1 N/A N/A N/A N/A N/A (N/A,

N/A) N/A

Tri-City Medical Center 1 N/A N/A N/A N/A N/A (N/A, N/A) N/A

Howe, Steven C. Surgeon Overall 2 2 0 0.00 1.75 0.00 (0.00, 100.00) Average

Temecula Valley Hospital 2 2 0 0.00 1.75 0.00 (0.00,

100.00) Average

Huang, Mark W. Surgeon Overall 91 72 2 2.78 2.32 2.55 (0.31, 9.20) Average




45


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Huang, Mark W. (continued)

Sharp Chula Vista Medical Center 88 69 2 2.90 2.32 2.66 (0.32,

9.59) Average

Huang, Ming–Lu Surgeon Overall 349 290 4 1.38 2.35 1.25 (0.34, 3.19) Average



5.42) Average


4.58) Average


9.37) Average

Huh, Joseph Surgeon Overall 154 74 0 0.00 2.53 0.00 (0.00, 4.19) Average


4.19) Average

Hunter, Curtis T. Surgeon Overall 76 53 0 0.00 1.61 0.00 (0.00, 9.16) Average


11.42) Average

Saint John's Health Center 19 11 0 0.00 1.54 0.00 (0.00,

46.35) Average

Hurwitz, Andrew S. Surgeon Overall 148 128 1 0.78 1.71 0.97 (0.02, 5.42) Average

California Hospital Medical Center – Los Angeles

2 2 0 0.00 2.44 0.00 (0.00, 100.00) Average


46


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Hurwitz, Andrew S. (continued)


40 36 1 2.78 1.46 4.04 (0.10, 22.50) Average

Glendale Memorial Hospital and Health Center

106 90 0 0.00 1.79 0.00 (0.00, 4.87) Average

Ingram, Michael T. Surgeon Overall 269 175 1 0.57 1.80 0.68 (0.02, 3.77) Average


3.77) Average

Iyengar, Sridhara K. Surgeon Overall 65 62 1 1.61 2.32 1.48 (0.04, 8.24) Average


2 2 0 0.00 0.52 0.00 (0.00, 100.00) Average


63 60 1 1.67 2.38 1.49 (0.04, 8.30) Average

Jain, Sarika Surgeon Overall 150 131 1 0.76 1.80 0.90 (0.02, 5.03) Average


149 130 1 0.77 1.79 0.91 (0.02, 5.09) Average


100.00) Average

Jolly, Shashank Surgeon Overall 107 93 0 0.00 1.73 0.00 (0.00, 4.86) Average


47


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Jolly, Shashank (continued)


4.86) Average

Jones, Blanding U. Surgeon Overall 261 216 3 1.39 1.77 1.67 (0.34, 4.87) Average

Kaiser Foundation Hospital – Fontana 1 1 0 0.00 0.95 0.00 (0.00,

100.00) Average


6.05) Average


10.66) Average

Joyo, Colin I. Surgeon Overall 109 81 0 0.00 2.22 0.00 (0.00, 4.37) Average


4.37) Average

Kallin, Kristopher Surgeon Overall 2 N/A N/A N/A N/A N/A (N/A, N/A) N/A

Kaiser Foundation Hospital – Sunset 2 N/A N/A N/A N/A N/A (N/A,

N/A) N/A

Kamlot, Andreas Surgeon Overall 115 97 1 1.03 1.60 1.37 (0.03, 7.62) Average


110 93 1 1.08 1.62 1.41 (0.04, 7.85) Average

John Muir Medical Center – Walnut Creek Campus

1 N/A N/A N/A N/A N/A N/A N/A


48


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Kamlot, Andreas (continued)


100.00) Average


100.00) Average

Kaplon, Richard J. Surgeon Overall 239 159 3 1.89 2.17 1.85 (0.38, 5.40) Average


16.26) Average


6.27) Average

Kass, Robert M. Surgeon Overall 3 2 0 0.00 0.48 0.00 (0.00, 100.00) Average


100.00) Average

Keyser, Eric Surgeon Overall 32 25 0 0.00 2.10 0.00 (0.00, 14.90) Average


32 25 0 0.00 2.10 0.00 (0.00, 14.90) Average

Khan, Ahmed M. Surgeon Overall 22 22 0 0.00 2.39 0.00 (0.00, 14.94) Average


63.89) Average


8 8 0 0.00 1.87 0.00 (0.00, 52.39) Average


49


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Khan, Ahmed M. (continued)


38.62) Average


100.00) Average

Khan, Junaid H. Surgeon Overall 147 113 0 0.00 1.80 0.00 (0.00, 3.86) Average

Alta Bates Summit Medical Center – Summit Campus

147 113 0 0.00 1.80 0.00 (0.00, 3.86) Average

Khan, Tanveer A. Surgeon Overall 109 94 1 1.06 1.68 1.35 (0.03, 7.51) Average


94 81 1 1.23 1.56 1.69 (0.04, 9.40) Average


32.81) Average


100.00) Average

Khoynezhad, Ali Surgeon Overall 28 13 0 0.00 1.04 0.00 (0.00, 57.82) Average


57.82) Average

Khwaja, Shamsuddin Surgeon Overall 389 328 5 1.52 2.41 1.35 (0.44, 3.14) Average


68 60 0 0.00 2.00 0.00 (0.00, 6.54) Average


50


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Khwaja, Shamsuddin (continued)


4.87) Average


4.90) Average

Kincade, Robert C. Surgeon Overall 296 210 2 0.95 2.22 0.91 (0.11, 3.29) Average

Mercy General Hospital 1 N/A N/A N/A N/A N/A (N/A,

N/A) N/A


3.29) Average

Klingman, Robert R. Surgeon Overall 132 114 6 5.26 2.38 4.70 (1.73, 10.23) Average


14.36) Average


14.17) Average


1 1 0 0.00 12.39 0.00 (0.00, 63.29) Average


Kochamba, Gary S. Surgeon Overall 261 209 3 1.44 2.23 1.37 (0.28, 4.01) Average


4.01) Average

Korver, Keith F. Surgeon Overall 222 183 2 1.09 1.37 1.70 (0.21, 6.15) Average


51


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Korver, Keith F. (continued) Marin General Hospital 46 38 0 0.00 1.18 0.00 (0.00,

17.48) Average


59 54 0 0.00 1.58 0.00 (0.00, 9.20) Average



13.17) Average

Koumjian, Michael P. Surgeon Overall 107 84 8 9.52 2.70 7.50 (3.24, 14.77) Worse

Alvarado Hospital 4 4 2 50.00 2.85 37.34 (4.52, 100.00) Worse




100.00) Average

Kwon, Murray H. Surgeon Overall 44 26 1 3.85 2.70 3.02 (0.08, 16.85) Average


16.85) Average

Kwon, Samantha E. Surgeon Overall 28 23 2 8.70 1.80 10.29 (1.25, 37.15) Average


52


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Kwon, Samantha E. (continued)


28 23 2 8.70 1.80 10.29 (1.25, 37.15) Average

Laks, Hillel Surgeon Overall 21 10 0 0.00 1.55 0.00 (0.00, 50.53) Average


50.53) Average

Lam, Tuan T. Surgeon Overall 242 203 3 1.48 2.24 1.40 (0.29, 4.10) Average


30 25 0 0.00 3.20 0.00 (0.00, 9.81) Average


8.43) Average

Orange Coast Memorial Medical Center

118 99 0 0.00 1.55 0.00 (0.00, 5.10) Average

Lapunzina, Paul M. Surgeon Overall 137 103 2 1.94 1.33 3.09 (0.37, 11.18) Average


137 103 2 1.94 1.33 3.09 (0.37, 11.18) Average

Larson, Craig R. Surgeon Overall 115 103 1 0.97 2.57 0.80 (0.02, 4.48) Average



53


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Lee, Anthony W. Surgeon Overall 61 52 2 3.85 1.37 5.96 (0.72, 21.54) Average

St. Francis Medical Center 61 52 2 3.85 1.37 5.96 (0.72,

21.54) Average

Lee, Hon S. Surgeon Overall 193 149 2 1.34 2.81 1.01 (0.12, 3.66) Average


3.66) Average

Lee, Jeffrey D. Surgeon Overall 49 37 0 0.00 1.80 0.00 (0.00, 11.80) Average


11.80) Average

Lee, Sang H. Surgeon Overall 229 183 2 1.09 3.00 0.77 (0.09, 2.80) Average

O'Connor Hospital – San Jose 76 59 2 3.39 2.67 2.70 (0.33,

9.75) Average

Regional Medical of San Jose 153 124 0 0.00 3.16 0.00 (0.00,

2.00) Better

Lemoine, Philippe H. Surgeon Overall 57 45 3 6.67 2.20 6.44 (1.33, 18.83) Average

Centinela Hospital Medical Center 20 16 2 12.50 2.76 9.62 (1.17,

34.76) Average

Providence Little Company of Mary Hospital

37 29 1 3.45 1.89 3.88 (0.10, 21.61) Average

Limmer, Karl K. Surgeon Overall 56 35 0 0.00 1.37 0.00 (0.00, 16.30) Average


54


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Limmer, Karl K. (continued)


16.30) Average

Lin, John C. Surgeon Overall 4 4 1 25.00 2.38 22.30 (0.56, 100.00) Average


100.00) Average


3 3 1 33.33 1.10 64.11 (1.62, 100.00) Average

Lin, Yuan H. Surgeon Overall 171 159 5 3.14 2.34 2.85 (0.93, 6.66) Average




29.63) Average

Liu, Minghui Surgeon Overall 283 247 7 2.83 2.79 2.16 (0.87, 4.45) Average


4.95) Average


8.34) Average


2 2 0 0.00 1.82 0.00 (0.00, 100.00) Average


55


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Longoria, James Surgeon Overall 228 147 2 1.36 2.42 1.20 (0.14, 4.32) Average


4.32) Average

MacMillan, James C. Surgeon Overall 130 101 4 3.96 3.48 2.42 (0.66, 6.19) Average


6.85) Average


32.09) Average


4 4 0 0.00 2.38 0.00 (0.00, 82.42) Average

Madani, Michael M. Surgeon Overall 36 15 0 0.00 1.31 0.00 (0.00, 39.85) Average


36 15 0 0.00 1.31 0.00 (0.00, 39.85) Average

Mahendra, Tom Surgeon Overall 32 31 3 9.68 2.68 7.67 (1.58, 22.41) Average

Antelope Valley Hospital 20 19 2 10.53 2.94 7.61 (0.92,

27.49) Average

Palmdale Regional 12 12 1 8.33 2.27 7.78 (0.20, 43.37) Average

Malekmehr, Farshad Surgeon Overall 62 61 1 1.64 1.55 2.24 (0.06, 12.50) Average


56


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Malekmehr, Farshad (continued)


12.50) Average

Malki, Alan E. Surgeon Overall 271 234 7 2.99 2.21 2.88 (1.16, 5.93) Average


10.80) Average


6.14) Average


14.98) Average

Marmureanu, Alexandru R. Surgeon Overall 25 22 3 13.64 1.61 18.04 (3.72, 52.72) Worse

Hollywood Presbyterian Medical Center

1 1 0 0.00 0.98 0.00 (0.00, 100.00) Average


54.23) Worse

Mayer, Frederick W. Surgeon Overall 8 5 0 0.00 0.75 0.00 (0.00, 100.00) Average


1 1 0 0.00 0.48 0.00 (0.00, 100.00) Average


100.00) Average


100.00) Average


57


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Mazur, Paul A. Surgeon Overall 73 63 1 1.59 1.90 1.78 (0.05, 9.91) Average


68.06) Average


60.93) Average

Tri-City Medical Center 60 51 1 1.96 1.86 2.24 (0.06, 12.46) Average

McConnell, Douglas H. Surgeon Overall 129 114 4 3.51 1.89 3.94 (1.07, 10.09) Average


100.00) Average


10.36) Average

McDonald, Jerome M. Surgeon Overall 10 8 0 0.00 2.80 0.00 (0.00, 34.97) Average



35.78) Average

McLean, Michael K. Surgeon Overall 32 29 2 6.90 1.92 7.65 (0.93, 27.63) Average


12 11 1 9.09 1.69 11.45 (0.29, 63.77) Average


100.00) Average


58


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

McLean, Michael K. (continued)


100.00) Average


33.48) Average

McPherson, James G. Surgeon Overall 35 32 1 3.13 1.83 3.64 (0.09, 20.26) Average


100.00) Average


13 11 0 0.00 1.93 0.00 (0.00, 36.97) Average


1 N/A N/A N/A N/A N/A N/A N/A


36.61) Average

Melikian, Vicken Surgeon Overall 87 54 0 0.00 1.24 0.00 (0.00, 11.75) Average


87 54 0 0.00 1.24 0.00 (0.00, 11.75) Average

Mellinger, Douglas N. Surgeon Overall 162 125 2 1.60 1.76 1.94 (0.23, 7.00) Average


7.00) Average

Merrick, Scot H. Surgeon Overall 107 86 1 1.16 1.62 1.52 (0.04, 8.48) Average


59


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Merrick, Scot H. (continued) Marin General Hospital 11 8 0 0.00 1.81 0.00 (0.00,

54.13) Average



61.11) Average

Meyer, Dan M. Surgeon Overall 19 15 0 0.00 2.01 0.00 (0.00, 25.94) Average


25.94) Average

Miller, David C. Surgeon Overall 13 2 0 0.00 1.73 0.00 (0.00, 100.00) Average


Milliken, Jeffrey C. Surgeon Overall 130 110 4 3.64 2.48 3.11 (0.85, 7.97) Average


7.97) Average

Minasyan, Sarah Z. Surgeon Overall 17 14 0 0.00 2.18 0.00 (0.00, 25.70) Average


26.00) Average


100.00) Average

Mitchell, Robert S. Surgeon Overall 42 31 1 3.23 1.43 4.79 (0.12, 26.67) Average


60


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Mitchell, Robert S. (continued) Stanford Hospital 42 31 1 3.23 1.43 4.79 (0.12,

26.67) Average

Mitruka, Surindra N. Surgeon Overall 88 75 0 0.00 1.89 0.00 (0.00, 5.53) Average

Dominican Hospital – Santa Cruz/Soquel 28 26 0 0.00 1.70 0.00 (0.00,

17.73) Average


8.04) Average

Mohammadzadeh, Gholam R. Surgeon Overall 145 123 4 3.25 3.31 2.09 (0.57, 5.34) Average


9.01) Average


10.09) Average


100.00) Average


10.02) Average

Montero, Erick L. Surgeon Overall 64 54 2 3.70 1.54 5.10 (0.62, 18.43) Average


58 49 2 4.08 1.64 5.28 (0.64, 19.06) Average


100.00) Average

Morales, Rodolfo A. Surgeon Overall 89 63 2 3.17 1.80 3.74 (0.45, 13.53) Average


61


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Morales, Rodolfo A. (continued)

Good Samaritan Hospital – San Jose 89 63 2 3.17 1.80 3.74 (0.45,

13.53) Average

Morenocabral, Ricardo J. Surgeon Overall 199 128 2 1.56 2.45 1.35 (0.16, 4.89) Average





9.93) Average

Morris, Allen S. Surgeon Overall 188 81 1 1.23 2.35 1.12 (0.03, 6.22) Average


6.31) Average


100.00) Average

Morrissey, James D. Surgeon Overall 315 250 11 4.40 3.01 3.10 (1.55, 5.55) Average



5.40) Average

Mudge, Devin R. Surgeon Overall 209 180 3 1.67 1.66 2.14 (0.44, 6.25) Average


62


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Mudge, Devin R. (continued)


18.48) Average


82.41) Average


7.95) Average


22.34) Average

Mumtaz, Seemal Surgeon Overall 26 24 0 0.00 1.77 0.00 (0.00, 18.48) Average


18.48) Average

Naficy, Sepehre Surgeon Overall 5 4 1 25.00 4.04 13.16 (0.33, 73.30) Average


73.30) Average

Nasseri, Andrew F. Surgeon Overall 9 8 0 0.00 0.64 0.00 (0.00, 100.00) Average


100.00) Average

Nucho, Ramsay C. Surgeon Overall 63 52 3 5.77 1.53 8.02 (1.65, 23.44) Average


30 25 2 8.00 1.57 10.85 (1.31, 39.20) Average

White Memorial Medical Center 33 27 1 3.70 1.49 5.27 (0.13,

29.36) Average


63


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

O'dorisio, James E. Surgeon Overall 4 4 0 0.00 1.27 0.00 (0.00, 100.00) Average


100.00) Average

Odeh, Yousef M. Surgeon Overall 12 10 2 20.00 1.62 26.17 (3.17, 94.53) Worse

Presbyterian Intercommunity Hospital

12 10 2 20.00 1.62 26.17 (3.17, 94.53) Worse

Ogden, William D. Surgeon Overall 61 42 0 0.00 1.55 0.00 (0.00, 12.02) Average

Santa Clara Valley Medical Center 61 42 0 0.00 1.55 0.00 (0.00,

12.02) Average

Oka, Tomomi Surgeon Overall 127 104 0 0.00 2.29 0.00 (0.00, 3.30) Average


12.40) Average



11.27) Average

Omari, Bassam O. Surgeon Overall 104 94 0 0.00 1.97 0.00 (0.00, 4.23) Average


85 76 0 0.00 1.96 0.00 (0.00, 5.25) Average


64


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Omari, Bassam O. (continued)

St. Francis Medical Center 1 1 0 0.00 2.67 0.00 (0.00,

100.00) Average


100.00) Average


47.80) Average

Torrance Memorial Medical Center 8 7 0 0.00 1.94 0.00 (0.00,

57.74) Average

Osman, Ashraf I. Surgeon Overall 89 74 0 0.00 1.86 0.00 (0.00, 5.69) Average


14 9 0 0.00 2.44 0.00 (0.00, 35.76) Average


30 27 0 0.00 1.63 0.00 (0.00, 17.84) Average


45 38 0 0.00 1.89 0.00 (0.00, 10.92) Average

Ott, Richard A. Surgeon Overall 494 413 4 0.97 2.39 0.86 (0.23, 2.20) Average


257 207 2 0.97 2.38 0.86 (0.10, 3.12) Average


3.24) Average


65


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Ott, Richard A. (continued) Western Medical Center Hospital – Anaheim

65 56 1 1.79 2.34 1.62 (0.04, 9.03) Average

Overton, John B. Surgeon Overall 25 25 2 8.00 1.68 10.13 (1.23, 36.61) Average


Palafox, Brian A. Surgeon Overall 171 96 6 6.25 2.41 5.52 (2.02, 12.00) Average

St. Joseph Hospital – Orange 169 94 5 5.32 2.39 4.73 (1.54,

11.04) Average


100.00) Average

Pamula, Ramesh B. Surgeon Overall 13 12 0 0.00 1.41 0.00 (0.00, 46.39) Average


11 11 0 0.00 1.48 0.00 (0.00, 48.20) Average


100.00) Average

Panagiotides, George P. Surgeon Overall 244 228 6 2.63 2.09 2.68 (0.98, 5.83) Average

Downey Regional Medical Center 68 66 1 1.52 1.77 1.82 (0.05,

10.12) Average


8.57) Average


66


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Panagiotides, George P. (continued)


13.46) Average


25.20) Average


100.00) Average

Paw, Patrick T. Surgeon Overall 176 158 2 1.27 2.13 1.26 (0.15, 4.56) Average

Bakersfield Heart Hospital 7 7 0 0.00 1.92 0.00 (0.00,

58.39) Average

Bakersfield Memorial Hospital – 34th Street 88 76 1 1.32 2.51 1.11 (0.03,

6.20) Average

San Joaquin Community Hospital 81 75 1 1.33 1.76 1.61 (0.04,

8.95) Average

Peck, Eric A. Surgeon Overall 125 108 3 2.78 2.68 2.20 (0.45, 6.44) Average


47.50) Average


7.23) Average


11.77) Average

Pellegrini, Daniel P. Surgeon Overall 91 69 4 5.80 1.07 11.48 (3.13, 29.40) Worse


91 69 4 5.80 1.07 11.48 (3.13, 29.40) Worse


67


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Perch, Paul G. Surgeon Overall 262 224 3 1.34 1.68 1.70 (0.35, 4.96) Average


5.45) Average


23.20) Average

Perkowski, David J. Surgeon Overall 119 100 0 0.00 2.51 0.00 (0.00, 3.12) Average


12 12 0 0.00 3.85 0.00 (0.00, 16.98) Average


3.82) Average

Perricone, Anthony Surgeon Overall 21 18 1 5.56 1.52 7.77 (0.20, 43.29) Average


21 18 1 5.56 1.52 7.77 (0.20, 43.29) Average

Petrik, Pavel V. Surgeon Overall 25 24 1 4.17 1.61 5.49 (0.14, 30.59) Average

Antelope Valley Hospital 19 18 1 5.56 1.50 7.85 (0.20,

43.71) Average

Palmdale Regional 6 6 0 0.00 1.94 0.00 (0.00, 67.44) Average

Pfeffer, Thomas A. Surgeon Overall 303 231 5 2.16 1.94 2.37 (0.77, 5.54) Average


68


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Pfeffer, Thomas A. (continued)


5.29) Average


32.81) Average

Poa, Li Surgeon Overall 209 142 4 2.82 2.74 2.19 (0.60, 5.59) Average


209 142 4 2.82 2.74 2.19 (0.60, 5.59) Average

Pompili, Mario F. Surgeon Overall 140 86 2 2.33 2.49 1.99 (0.24, 7.18) Average


7.18) Average

Postel, Joachim M. Surgeon Overall 54 37 1 2.70 1.79 3.20 (0.08, 17.85) Average

St. Joseph Hospital – Eureka 54 37 1 2.70 1.79 3.20 (0.08,

17.85) Average

Pottmeyer, Edward W. Surgeon Overall 259 219 6 2.74 2.87 2.03 (0.75, 4.42) Average


4.42) Average

Pretorius, Gertdiederick V. Surgeon Overall 94 47 0 0.00 1.97 0.00 (0.00, 8.48) Average


94 47 0 0.00 1.97 0.00 (0.00, 8.48) Average


69


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Puig–Palomar, Miguel Surgeon Overall 287 244 5 2.05 2.13 2.04 (0.66, 4.77) Average


4.77) Average

Purewal, Sarabjit S. Surgeon Overall 316 253 7 2.77 1.86 3.15 (1.27, 6.50) Average


9.77) Average


8.15) Average


16.56) Average

Pusca, Sorin V. Surgeon Overall 2 2 0 0.00 6.72 0.00 (0.00, 58.33) Average


58.33) Average

Rabkin, David G. Surgeon Overall 70 65 3 4.62 2.34 4.20 (0.87, 12.27) Average


45 42 1 2.38 2.14 2.37 (0.06, 13.20) Average


24.68) Average

Raissi, Sharo Surgeon Overall 22 10 0 0.00 4.07 0.00 (0.00, 19.27) Average


19.27) Average


70


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Ramzy, Danny Surgeon Overall 81 55 0 0.00 1.80 0.00 (0.00, 7.94) Average


7.94) Average

Raney, Aidan A. Surgeon Overall 98 44 0 0.00 1.48 0.00 (0.00, 12.04) Average


12.04) Average

Rasi, Alfredo L. Surgeon Overall 92 76 1 1.32 2.53 1.11 (0.03, 6.16) Average



16.23) Average

Razzouk, Anees J. Surgeon Overall 115 69 0 0.00 2.81 0.00 (0.00, 4.04) Average



4.08) Average

Reemtsen, Brian L. Surgeon Overall 1 N/A N/A N/A N/A N/A (N/A, N/A) N/A

Ronald Reagan UCLA Medical Center 1 N/A N/A N/A N/A N/A (N/A,

N/A) N/A

Richter, Richard C. Surgeon Overall 68 57 0 0.00 1.25 0.00 (0.00, 11.02) Average


71


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Richter, Richard C. (continued)


68 57 0 0.00 1.25 0.00 (0.00, 11.02) Average

Roberts, Randall F. Surgeon Overall 206 177 6 3.39 2.44 2.95 (1.08, 6.43) Average


45 40 0 0.00 3.80 0.00 (0.00, 5.16) Average


44 37 3 8.11 1.60 10.79 (2.22, 31.52) Worse


117 100 3 3.00 2.21 2.89 (0.60, 8.44) Average

Robertson, John M. Surgeon Overall 72 61 5 8.20 1.79 9.75 (3.16, 22.75) Worse


22.75) Worse

Rosenburg, Jeffrey M. Surgeon Overall 38 31 1 3.23 1.78 3.86 (0.10, 21.50) Average


21.50) Average

Sakopoulos, Andreas G. Surgeon Overall 105 85 4 4.71 2.16 4.62 (1.26, 11.83) Average


Salem, Fakhri M. Surgeon Overall 121 112 3 2.68 2.13 2.68 (0.55, 7.82) Average


72


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Salem, Fakhri M. (continued) Grossmont Hospital 8 6 0 0.00 2.13 0.00 (0.00,

61.29) Average



100.00) Average

Schwartz, Steven M. Surgeon Overall 66 52 3 5.77 2.52 4.87 (1.01, 14.25) Average


14.35) Average


100.00) Average

Serna, Daniel L. Surgeon Overall 378 325 3 0.92 1.58 1.24 (0.26, 3.63) Average


16.17) Average


4.01) Average

Shafi, Bilal M. Surgeon Overall 61 36 0 0.00 2.74 0.00 (0.00, 7.96) Average

Community Hospital Monterey Peninsula 1 N/A N/A N/A N/A N/A (N/A,

N/A) N/A


7.96) Average

Shah, Aamir S. Surgeon Overall 6 4 0 0.00 4.02 0.00 (0.00, 48.74) Average


73


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Shah, Aamir S. (continued) Cedars Sinai Medical Center 6 4 0 0.00 4.02 0.00 (0.00,

48.74) Average

Shah, Sachin Surgeon Overall 40 31 2 6.45 3.35 4.09 (0.50, 14.78) Average


35 27 1 3.70 3.67 2.14 (0.05, 11.94) Average


100.00) Average


100.00) Worse

Sharma, Kapil Surgeon Overall 172 113 3 2.65 2.35 2.40 (0.50, 7.02) Average


7.27) Average


83.84) Average

Shayan, Hossein Surgeon Overall 175 135 4 2.96 1.92 3.28 (0.89, 8.39) Average


33.57) Average


8.31) Average

Sheikh, Ahmad Y. Surgeon Overall 106 86 1 1.16 1.50 1.65 (0.04, 9.18) Average


100.00) Average


74


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Sheikh, Ahmad Y. (continued) Santa Clara Valley Medical Center 100 83 1 1.20 1.48 1.73 (0.04,

9.65) Average

Stanford Hospital 3 N/A N/A N/A N/A N/A N/A N/A

Shemin, Richard J. Surgeon Overall 133 51 1 1.96 2.58 1.61 (0.04, 8.99) Average


8.99) Average

Shuman, Robert L. Surgeon Overall 37 35 2 5.71 3.16 3.84 (0.47, 13.89) Average

Lakewood Regional Medical Center 1 N/A N/A N/A N/A N/A (N/A,

N/A) N/A


13.89) Average

Silva, Raymond Surgeon Overall 38 31 1 3.23 2.79 2.46 (0.06, 13.71) Average


16.57) Average

Regional Medical of San Jose 3 2 0 0.00 2.89 0.00 (0.00,

100.00) Average


86.28) Average

Slachman, Frank N. Surgeon Overall 170 97 0 0.00 1.98 0.00 (0.00, 4.09) Average


4.46) Average


75


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Slachman, Frank N. (continued)


48.68) Average

Soltero, Michael J. Surgeon Overall 123 98 4 4.08 1.85 4.68 (1.27, 11.98) Average


13.15) Average


36.21) Average


22.43) Average


100.00) Average


100.00) Average


100.00) Average

Spowart, Gregory S. Surgeon Overall 186 142 1 0.70 1.93 0.78 (0.02, 4.33) Average

Community Hospital Monterey Peninsula 186 142 1 0.70 1.93 0.78 (0.02,

4.33) Average

Stahl, Richard D. Surgeon Overall 222 151 2 1.32 2.62 1.07 (0.13, 3.88) Average


3.88) Average

Stanten, Russell D. Surgeon Overall 101 81 1 1.23 2.17 1.21 (0.03, 6.73) Average


76


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Stanten, Russell D. (continued)


101 81 1 1.23 2.17 1.21 (0.03, 6.73) Average

Starnes, Vaughn A. Surgeon Overall 94 36 2 5.56 1.59 7.44 (0.90, 26.86) Average


Stein, Alexander G. Surgeon Overall 90 74 1 1.35 3.39 0.85 (0.02, 4.73) Average


58.07) Average


4.99) Average

Stewart, Robert D. Surgeon Overall 136 110 6 5.45 2.37 4.89 (1.80, 10.65) Average


83 66 5 7.58 2.99 5.39 (1.75, 12.57) Average


24.29) Average


38.02) Average

Stoneburner, John M. Surgeon Overall 99 61 1 1.64 1.41 2.47 (0.06, 13.78) Average


13.78) Average


77


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Sun, Jack C. Surgeon Overall 26 19 0 0.00 1.73 0.00 (0.00, 23.89) Average


2 2 0 0.00 0.78 0.00 (0.00, 100.00) Average


25.08) Average

Talieh, Yahya J. Surgeon Overall 81 70 1 1.43 2.12 1.43 (0.04, 7.97) Average


39.39) Average


55 52 1 1.92 2.48 1.65 (0.04, 9.20) Average

Tang, Eddie Surgeon Overall 48 44 4 9.09 2.57 7.53 (2.05, 19.28) Average


54.82) Average

Regional Medical Center of San Jose 11 11 2 18.18 4.23 9.13 (1.11,

32.99) Average


20.44) Average

Taylor, Benedict J. Surgeon Overall 34 28 1 3.57 2.30 3.30 (0.08, 18.36) Average

Santa Barbara Cottage Hospital 34 28 1 3.57 2.30 3.30 (0.08,

18.36) Average


78


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Tedesco, Dominic J. Surgeon Overall 110 87 1 1.15 2.06 1.19 (0.03, 6.62) Average


110 87 1 1.15 2.06 1.19 (0.03, 6.62) Average

Tendulkar, Amod P. Surgeon Overall 180 159 5 3.14 2.21 3.02 (0.98, 7.05) Average



7.15) Average

Thibault, William N. Surgeon Overall 99 89 0 0.00 3.37 0.00 (0.00, 2.61) Average


22 21 0 0.00 4.20 0.00 (0.00, 8.89) Average


100.00) Average


3.78) Average

Thomas, Donald D. Surgeon Overall 5 4 0 0.00 1.57 0.00 (0.00, 100.00) Average


100.00) Average

Toporoff, Bruce M. Surgeon Overall 79 65 1 1.54 2.43 1.35 (0.03, 7.50) Average


79


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Toporoff, Bruce M. (continued)


5 5 0 0.00 2.21 0.00 (0.00, 70.84) Average


35.09) Average


6.93) Average

Tovar, Eduardo A. Surgeon Overall 249 108 0 0.00 2.17 0.00 (0.00, 3.34) Average

Presbyterian Intercommunity Hospital

249 108 0 0.00 2.17 0.00 (0.00, 3.34) Average

Trento, Alfredo Surgeon Overall 126 55 0 0.00 0.87 0.00 (0.00, 16.35) Average


16.35) Average

Trivedi, Rohitkumar R. Surgeon Overall 80 67 4 5.97 2.50 5.08 (1.38, 13.00) Average



100.00) Average

Tsau, Pei H. Surgeon Overall 147 124 2 1.61 2.45 1.40 (0.17, 5.05) Average


17.66) Average


80


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Tsau, Pei H. (continued) El Camino Hospital 104 83 2 2.41 2.86 1.79 (0.22, 6.47) Average


34.70) Average

Tyner, John J. Surgeon Overall 135 79 0 0.00 1.10 0.00 (0.00, 8.99) Average


10.02) Average


87.71) Average

Veeragandham, Ramesh S. Surgeon Overall 123 89 0 0.00 2.50 0.00 (0.00, 3.52) Average


104 77 0 0.00 2.40 0.00 (0.00, 4.24) Average


70.81) Average


29.25) Average

Vial, Conrad M. Surgeon Overall 90 54 1 1.85 1.45 2.71 (0.07, 15.11) Average


34.01) Average



25.60) Average


81


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Vial, Conrad M. (continued) Sequoia Hospital 1 1 0 0.00 1.94 0.00 (0.00, 100.00) Average

Vo, Quang T. Surgeon Overall 69 58 4 6.90 2.60 5.63 (1.53, 14.42) Average

Beverly Hospital 1 1 0 0.00 0.60 0.00 (0.00,

100.00) Average


19.51) Average


29 29 2 6.90 2.20 6.66 (0.81, 24.04) Average


50.65) Average


100.00) Average

Vunnamadala, Syam P. Surgeon Overall 91 82 3 3.66 2.34 3.32 (0.68, 9.70) Average


38 30 0 0.00 2.18 0.00 (0.00, 11.97) Average

West Anaheim Medical Center 47 46 2 4.35 2.24 4.13 (0.50,

14.92) Average


92.78) Average

Western Medical Center Hospital – Anaheim

5 5 0 0.00 2.19 0.00 (0.00, 71.51) Average


82


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Wang, Nan Surgeon Overall 185 133 3 2.26 2.28 2.11 (0.43, 6.15) Average


36.42) Average


6.63) Average

West, Phillip N. Surgeon Overall 173 135 2 1.48 1.79 1.76 (0.21, 6.35) Average


6.35) Average

Wieselthaler, Georg M. Surgeon Overall 35 28 1 3.57 2.12 3.58 (0.09, 19.92) Average


Wilson, Joseph W. Surgeon Overall 292 229 3 1.31 2.66 1.05 (0.22, 3.06) Average


3.06) Average

Woo, Yi–Ping J. Surgeon Overall 49 33 0 0.00 2.13 0.00 (0.00, 11.18) Average


Yap, Alexander G. Surgeon Overall 57 51 2 3.92 2.34 3.56 (0.43, 12.88) Average



83


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Yap, Alexander G. (continued)


100.00) Average

Yasuda, Roderick K. Surgeon Overall 128 106 0 0.00 2.37 0.00 (0.00, 3.13) Average


17.70) Average


13.00) Average


10.70) Average


27.74) Average


32.17) Average


38.62) Average

Yokoyama, Taro Surgeon Overall 192 165 6 3.64 1.85 4.18 (1.54, 9.11) Average


27.35) Worse


81 77 2 2.60 1.88 2.93 (0.36, 10.60) Average


33.45) Average


13.77) Average


84


CABG Cases

Isolated CABG Cases


Observed Mortality

Rate (%)

Expected Mortality

Rate (%)


(%, RAMR)

95% CI for

RAMR Performance

Rating*

State 31,261 24,092† 512 2.13

Young, Joseph N. Surgeon Overall 74 37 1 2.70 1.20 4.79 (0.12, 26.68) Average


26.68) Average

Yun, Kwok L. Surgeon Overall 283 161 0 0.00 1.82 0.00 (0.00, 2.67) Average


2.68) Average

Kaiser Foundation Hospital – Fontana 1 N/A N/A N/A N/A N/A N/A N/A


100.00) Average

Zhu, Henry L. Surgeon Overall 274 178 1 0.56 2.20 0.54 (0.01, 3.03) Average


3.03) Average

Mercy San Juan Hospital 2 N/A N/A N/A N/A N/A N/A N/A

Zusman, Douglas R. Surgeon Overall 56 44 1 2.27 2.18 2.21 (0.06, 12.33) Average


12.33) Average

Note: Not Applicable, Non-isolated CABG cases were not used to determine performance ratings in this report.

*A surgeon is classified as “Better” if the upper 95% CI of the RAMR falls below the average observed mortality rate (2.13%). A surgeon is classified as “Worse” if the lower 95% CI of the RAMR is higher than the average observed mortality rate. A surgeon’s performance is considered “Average” if the average mortality rate falls within the 95% CI of a surgeon’s RAMR. † The number of isolated CABG cases by surgeon may not equal the total number of isolated CABG cases reported due to various reason, including but not limited to surgeon appeals.


85

Risk Model for Adjusting Hospital CABG + Valve Operative Mortality Rates, 2013-2014 Performance ratings for hospitals performing CABG + valve surgery are based on operations performed in 2013 or 2014 that combined CABG and aortic valve replacement, mitral valve repair or mitral valve replacement procedures. These operations exclude those patients in salvage operative status. To develop the risk model for hospital CABG + valve operative mortality, the 5,132 CABG + valve cases in 2013-2014 were evaluated for missing data; 5,023 cases had no missing data in any field and were used for the risk model parameter estimation. The 109 (0.2%) CABG + valve cases with missing data fields were removed to ensure that the effects of risk factors were estimated based on the most complete data available. To generate the hospital specific results shown in this report, missing values for these 109 records were imputed (after risk model parameter estimation) by replacing them with the lowest risk category of the same variable (e.g., Chronic Lung Disease = none). The risk model, based on the 2013-2014 data, is presented in Table D-1 with statistically significant risk factors identified in bolded text. Table D-1: Logistic Regression Risk Model for CABG + Valve Operative Mortality, 2013-2014

Risk Factor Coefficient Standard Error P-value Odds

Ratio Intercept -7.4169 0.7494 <.0001

Surgery Type

AVR+CABG Reference

MV Repair+CABG 0.00901 0.2285 0.9685 0.936 MV

Replacement+CABG 0.5070 0.2338 0.0302 1.575

AVR+MVR+CABG 0.9655 0.2302 <0.001 2.638 Age (Years) 0.0329 0.00761 <0.001 1.033


Female 0.3806 0.1402 0.0066 1.459


Non-White 0.1216 0.1447 0.4008 1.126

Body Mass Index 18.5-39.9 Reference

<18.5 0.3892 0.4014 0.3323 1.439 >=40.0 0.2152 0.3504 0.5391 1.206

Status of the Procedure

Elective Reference

Urgent 0.4326 0.1530 0.0047 1.568 Emergent 0.5797 0.4510 0.1987 1.642

Last Creatinine Level (mg/dl) 1.1324 0.3056 0.0002 3.168 Hypertension -0.0966 0.2011 0.6311 0.91 Peripheral Arterial Disease -0.0502 0.1677 0.7646 0.935 Cerebrovascular Disease 0.0763 0.1980 0.7000 1.08


86

Table D-1: Logistic Regression Risk Model for CABG + Valve Operative Mortality, 2013-2014

Risk Factor Coefficient Standard Error P-value Odds

Ratio

Diabetes Control No Diabetes Reference

Non-Insulin -0.1458 0.1486 0.3265 0.865 Insulin -0.0688 0.1954 0.7246 0.927

Chronic Lung Disease Severe vs. None, Mild, and Moderate 0.00521 0.2505 0.9834 0.991

Immunocompromise 0.7620 0.2378 0.0014 2.112 Dialysis 0.1857 0.3003 0.5364 1.18 Atrial Fibrillation/Flutter 0.1670 0.1512 0.2694 1.198 Third Degree Heart Block -1.2033 1.0362 0.2455 0.302


No MI Reference

21 or more days 0.2260 0.1764 0.2002 1.255 8-20 days ago -0.1067 0.2933 0.7160 0.903 1-7 days ago -0.0676 0.2035 0.7398 0.907

Within 24 Hours 0.8342 0.4493 0.0633 2.104 Cardiogenic Shock 1.5622 0.6707 0.0199 2.518

NYHA Classification I,II, or III Reference

IV 0.4049 0.1607 0.0117 1.475

Prior Cardiac Surgery None Reference

One or more 0.4367 0.2694 0.1050 1.55 Previous Valve Surgery

0.1054 0.3933 0.7886 1.121

Ejection Fraction (%) -0.00442 0.00491 0.3676 0.996 Left Main Disease (≥ 50%) 0.3931 0.1535 0.0104 1.47 Number of Diseased Vessels

None, One, or Two Reference

Three or more 0.2086 0.1435 0.1461 1.221

Mitral Insufficiency None/Trivial/Mild Reference

Moderate/Severe -03334 0.1773 0.0600 0.733 Infectious Endocarditis

-0.00129 0.3396 0.9970 1.015

MELD Score ≥ 10 vs. <10 0.3922 0.1618 0.0154 1.473 MELD: Model for End-Stage Liver Disease Bolded text indicates statistically significant. AV/MV=aortic valve, mitral valve repair or replacement Note: Last Creatinine level and Ejection Fraction were modeled using piecewise linear transformations.

Discrimination of Risk Model for CABG + Valve Operative Mortality Discrimination methods are explained in the section for isolated CABG operative mortality. For the 2013-2014 risk model, the C-statistic was 0.751. In recently published CABG + valve surgery mortality reports by the STS, the C-statistic was 0.75 (Ann Thorac Surg 2009; 88:S43–62).


87

Calibration of Risk Model for CABG + Valve Operative Mortality Calibration methods are explained in the section for isolated CABG operative mortality. The p-value of the Hosmer-Lemeshow test statistic for this 2013-2014 risk model is 0.411, indicating there were no significant differences between observed and predicted outcomes over deciles of risk. As presented in Table D-2, Risk Group 10 shows the patients in the highest risk group. Among the 503 patients in Group 10, 96 patients died, and the model predicted 101.48 patient deaths. Assuming a Poisson distribution for a binary outcome, the predicted range of deaths for Risk Group 10 is 82.7 to 123.24. The observed number of 96 deaths falls within the range of predicted deaths. In fact, none of the ten risk groups had significantly fewer or significantly more deaths than were predicted by the model. Table D-2: Calibration of Risk Model for CABG + Valve Operative Mortality, 2013-2014

Risk Group

AV/MV + CABG Cases

Observed Deaths

Predicted Deaths Difference 95%CI of Predicted

Deaths

1 502 3 6.32 3.32 2.39 13.50 2 502 12 9.06 -2.94 4.15 17.16 3 503 11 11.42 0.42 5.79 20.22 4 502 8 13.80 5.80 7.51 23.24 5 503 18 16.75 -1.25 9.71 26.91 6 502 22 20.38 -1.62 12.52 31.36 7 502 23 25.08 2.08 16.24 36.90 8 502 31 32.75 1.75 22.51 46.04 9 502 61 47.96 -13.00 35.36 63.60

10 503 96 101.48 5.48 82.70 123.24 Note: Risk Group 1 is at lowest risk for mortality and Risk Group 10 is at highest risk.

Process for Calculating Hospital Risk-Adjusted CABG + Valve Mortality Rates and Performance Rating The RAMR is computed by dividing the provider’s observed mortality by the provider’s expected mortality (based on the risk model) to get the observed/expected (O/E) ratio. The O/E ratio is then multiplied by the statewide average mortality rate (5.68% in 2013-2014) to obtain the provider’s RAMR. However, because a provider’s point estimate of the RAMR can be attributed to chance, the performance rating is not based on the point estimate of the RAMR, but a comparison of the 95% CI of each provider’s RAMR to the statewide mortality rate.3 CCORP treated the 2013-2014 data as a sample, and inferred a range within which each provider’s true performance was likely to fall. As shown in Table D-3, a provider’s performance rating is “Better” if the upper 95% CI of a provider’s risk-adjusted mortality is below the state average mortality rate (indicating the provider’s RAMR is significantly lower than the state average). A provider’s performance rating is “Worse” if the lower

3 CCORP uses the Poisson Exact Probability method to compute the 95% confidence interval for the risk-adjusted mortality rate (Buchan Iain, Calculating Poisson Confidence Interval in Excel, January 2004).


88

95% CI of a provider’s RAMR is above the state average mortality rate (indicating the provider’s risk-adjusted mortality is significantly higher than the state average). If the state average mortality rate is within the 95% CI of a provider’s RAMR, then the performance rating is “Average.”

Hospital CABG + Valve Operative Mortality Results, 2013-2014 Among the 5,132 CABG + valve and non-salvage surgeries performed at 127 hospitals in 2013-2014, 309 patients died either in-hospital or within 30 days of the surgery date, reflecting a statewide operative mortality rate of 5.68%. The observed mortality rates among hospitals ranged from 0% to 100.00%. The expected mortality rates, which are generated by the risk model and account for patient severity-of-illness, were between 2.06% and 13.87%. The RAMR, which measure hospital performance, ranged from 0% to 92.28%.

Based on the 95% confidence intervals for RAMR, six hospitals were rated “Better” (Eisenhower Medical Center, Kaiser Foundation Hospital – San Francisco, Mercy General Hospital, Presbyterian Intercommunity Hospital, Scripps Memorial Hospital – La Jolla, and Sequoia Hospital) and one hospital performed “Worse” (Dominican Hospital – Santa Cruz/Soquel) than the state average. The remaining 120 hospitals performed within the expected range when compared to the statewide mortality rate (Table D-3).


89

Table D-3: Hospital Risk-Adjusted CABG + Valve Operative Mortality Results by Region, 2013-2014

Region Hospital All

CABG Cases

CABG +

AV/MV Cases

CABG + AV/MV

Operative Deaths

Observed Operative Mortality Rate (%)

Expected Operative Mortality Rate (%)

Risk-Adjusted Operative

Mortality Rate (%, RAMR)

95%CI for RAMR

Performance Rating*

State 31,261 5,239 293 5.59



Mercy General Hospital 1,353 376 10 2.66 5.07 2.93 (1.41, 5.39) Better




Shasta Regional Medical Center 153 17 0 0.00 2.65 0.00 (0.00, 45.80) Average






293 56 6 10.71 6.20 9.66 (3.55, 21.03) Average



Dominican Hospital – Santa Cruz/Soquel 168 36 5 13.89 4.16 18.68 (6.06, 43.59) Worse



90

Region Hospital All

CABG Cases

CABG +

AV/MV Cases

CABG + AV/MV

Operative Deaths





95%CI for RAMR

Performance Rating*

State 31,261 5,239 293 5.59




John Muir Medical Center – Walnut Creek Campus 1 . . . . . (., .) Not Applicable

Kaiser Foundation Hospital – San Francisco 814 130 0 0.00 3.39 0.00 (0.00, 4.68) Better












91

Region Hospital All

CABG Cases

CABG +

AV/MV Cases

CABG + AV/MV

Operative Deaths





95%CI for RAMR

Performance Rating*

State 31,261 5,239 293 5.59



Sequoia Hospital 173 57 0 0.00 7.05 0.00 (0.00, 5.13) Better









Central California



Community Regional Medical Center – Fresno 521 51 2 3.92 6.30 3.48 (0.42, 12.58) Average





92

Region Hospital All

CABG Cases

CABG +

AV/MV Cases

CABG + AV/MV

Operative Deaths





95%CI for RAMR

Performance Rating*

State 31,261 5,239 293 5.59






Saint Agnes Medical Center 568 92 4 4.35 5.55 4.38 (1.19, 11.22) Average


St. Joseph’s Medical Center of Stockton 503 71 4 5.63 7.05 4.47 (1.22, 11.44) Average







Los Robles Hospital and Medical Center 185 39 5 12.82 5.41 13.25 (4.30, 30.93) Average



93

Region Hospital All

CABG Cases

CABG +

AV/MV Cases

CABG + AV/MV

Operative Deaths





95%CI for RAMR

Performance Rating*

State 31,261 5,239 293 5.59


Palmdale Regional Medical Center 18 . . . . . (., .) Not Applicable





St. John’s Regional Medical Center 176 27 5 18.52 10.40 9.95 (3.23, 23.23) Average


West Hills Regional Medical Center 109 12 0 0.00 4.60 0.00 (0.00, 37.34) Average

Greater Los Angeles








94

Region Hospital All

CABG Cases

CABG +

AV/MV Cases

CABG + AV/MV

Operative Deaths





95%CI for RAMR

Performance Rating*

State 31,261 5,239 293 5.59







Kaiser Foundation Hospital – Sunset 1,426 272 11 4.04 5.79 3.91 (1.95, 6.99) Average






224 28 1 3.57 4.31 4.64 (0.12, 25.83) Average



95

Region Hospital All

CABG Cases

CABG +

AV/MV Cases

CABG + AV/MV

Operative Deaths





95%CI for RAMR

Performance Rating*

State 31,261 5,239 293 5.59


Presbyterian Intercommunity Hospital 261 111 2 1.80 8.41 1.20 (0.15, 4.33) Better

Providence Little Company of Mary Medical Center – Torrance

247 59 6 10.17 4.87 11.68 (4.28, 25.41) Average


Saint John’s Health Center 113 23 1 4.35 5.94 4.09 (0.10, 22.81) Average







Desert Regional Medical Center 265 33 3 9.09 5.69 8.94 (1.84, 26.12) Average


Eisenhower Medical Center 319 49 0 0.00 8.21 0.00 (0.00, 5.13) Better




96

Region Hospital All

CABG Cases

CABG +

AV/MV Cases

CABG + AV/MV

Operative Deaths





95%CI for RAMR

Performance Rating*

State 31,261 5,239 293 5.59

Inland Empire, Riverside & San Bernardino (continued)





St. Bernardine Medical Center 1049 47 4 8.51 6.50 7.32 (1.99, 18.74) Average


Temecula Valley Hospital 16 . . . . . (., .) Not Applicable

Orange County



232 14 3 21.43 4.78 25.05 (5.17, 73.21) Average






97

Region Hospital All

CABG Cases

CABG +

AV/MV Cases

CABG + AV/MV

Operative Deaths





95%CI for RAMR

Performance Rating*

State 31,261 5,239 293 5.59

Orange County (continued)







Greater San Diego





Scripps Memorial Hospital – La Jolla 698 175 1 0.57 4.89 0.65 (0.02, 3.64) Better



Sharp Memorial Hospital† 364 101 4 3.96 4.11 5.38 (1.47, 13.79) Average



98

Region Hospital All

CABG Cases

CABG +

AV/MV Cases

CABG + AV/MV

Operative Deaths





95%CI for RAMR

Performance Rating*

State 31,261 5,239 293 5.59



288 61 1 1.64 4.53 2.03 (0.05, 11.29) Average

AV/MV=aortic valve, mitral valve repair or replacement

*A hospital is classified as “Better” if the upper 95% CI of the RAMR falls below the California observed mortality rate (5.59%). A hospital is classified as “Worse” if the lower 95% CI of the RAMR is higher than the statewide observed mortality rate. A hospital’s performance is considered “Average” if the statewide average mortality rate falls within the 95% CI of a hospital’s RAMR.


99

Risk Model for Adjusting Hospital Post-Operative Stroke Rates, 2013-2014 Post-operative stroke is a fairly rare but serious complication that can occur after CABG surgery. To assess hospital performance on this outcome, CCORP combined 2013 and 2014 data to increase the number of cases and reliability of hospital results. Similar to the methodology used to assess the operative mortality rate, CCORP used a multivariable logistic regression model to estimate the relationship between each of the demographic and pre-operative risk factors and the probability of post-operative stroke. The risk model, based on the 2013-2014 data, is presented in Table E-1 with statistically significant risk factors identified in bolded text.

Table E-1: Logistic Regression Risk Model for Post-Operative Stroke, 2013-2014

Risk Factors Coefficient Standard Error P-value Odds Ratio Intercept -6.6381 0.6193 <.0001

Age (Years) 0.0183 0.00612 0.0028 1.018


Female 0.2531 0.1299 0.0515 1.288


Non-White 0.1374 0.1219 0.2598 1.147

Status of the Procedure

Elective Reference

Urgent 0.4181 0.1599 0.0089 1.519 Emergent 0.8143 0.3056 0.0077 2.258

Last Creatinine Level Pre-Op (mg/dl) 0.0465 0.2394 0.8460 1.048 Hypertension -0.00037 0.2133 0.9986 1 Peripheral Arterial Disease 0.3839 0.1474 0.0092 1.468 Cerebrovascular Disease 0.9440 0.1289 <.0001 2.5

Diabetes Control

No Diabetes Reference Non-Insulin 0.3543 0.1391 0.0109 1.425

Insulin 0.4803 0.1668 0.0040 1.617 Chronic Lung Disease

None/Mild/Moderate Reference Severe -0.1726 0.2746 0.5298 0.842

Atrial Fibrillation/Flutter 0.3819 0.1697 0.0245 1.465 Arrhythmia Vtach -0.2279 0.3220 0.4790 0.796


No MI Reference

21 or more days ago -0.00886 0.1861 0.9620 0.991 8-20 days ago 0.1818 0.2432 0.4548 1.199 1-7 days ago 0.2277 0.1564 0.1455 1.256

Within 24 Hours 0.6095 0.2762 0.0273 1.84 Cardiogenic Shock 0.6667 0.3670 0.0692 1.948 Heart Failure 0.1394 0.1597 0.3827 1.15 NYHA Classifications IV vs. I,II,III 0.1911 0.2006 0.3409 1.211 Ejection Fraction (%) -0.00541 0.00472 0.2518 0.995


100

Table E-1: Logistic Regression Risk Model for Post-Operative Stroke, 2013-2014

Risk Factors Coefficient Standard Error P-value Odds Ratio Left Main Disease (≥ 50%) -0.1348 0.1249 0.2803 1.874

Number of Diseased Vessels

None, One or Two Reference

Three or More 0.1495 0.1515 0.3239 1.161 MELD Score 10 1 vs 0 0.2914 0.1659 0.0790 1.338 Year 2013 vs. 2014 -0.1170 0.1174 0.3189 0.89

MELD: Model for End-Stage Liver Disease Bolded text indicates statistical significance. Note: “Last Creatinine Level” and “Ejection Fraction” were modeled using piecewise linear transformations.

Discrimination of Risk Model for Post-Operative Stroke For the 2013-2014 risk model, the C-statistic was 0.729. The CCORP 2013-2014 risk model compares favorably with the STS’ recently published post-operative stroke model (C-statistic = 0.716 for isolated CABG surgery).4

Calibration of Risk Model for Post-Operative Stroke A common measure of calibration is the Hosmer-Lemeshow χ2 test, which compares observed and predicted outcomes over deciles of risk. The p-value of the Hosmer-Lemeshow test statistic for this post-operative stroke risk model is 0.091, indicating adequate calibration. A second calibration test sorts the data and compares observed stroke cases with predicted stroke cases in each of 10 risk groups. As presented in Table E-2, Risk Group 2 shows the patients in the second lowest risk group. Among the 2,348 patients in this group, 7 patients had post-operative strokes, but the model predicted 11.05 cases. Assuming a Poisson distribution for a binary outcome, the predicted range of strokes for this group is 5.53 to 19.75. The observed number of 7 strokes falls within the range of predicted strokes. In fact, 9 of the 10 risk groups have neither significantly fewer nor significantly more post-operative strokes than were predicted by the model. Overall, the risk model shows no systematic underestimation or overestimation of stroke cases at the extremes.

4 Shahian DM, O'Brien SM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1—coronary artery bypass grafting surgery. Ann Thorac Surg 2011; 88:S2-22.


101

Table E-2: Calibration of Risk Model for Post-Operative Stroke, 2013-2014

Risk Group

Isolated CABG Cases

Observed Post-Op Strokes

Predicted Post-Op Stroke Difference 95%CI of Predicted

Post-Op Stroke 1 2,348 2 8.05 6.02 3.48 15.82 2 2,348 7 11.05 3.05 5.53 19.75 3 2,349 16 13.41 -2.59 7.22 22.74 4 2,349 10 15.83 5.83 9.01 25.77 5 2,350 20 18.70 -1.30 11.21 29.31 6 2,350 27 22.28 -4.72 14.01 33.64 7 2,348 31 27.24 -3.76 17.99 39.57 8 2,349 42 34.84 -7.16 24.24 48.49 9 2,348 62 52.30 -9.7 35.95 64.38 10 2,344 85 87.95 2.95 83.12 123.77

Note: Risk Group 1 is at lowest risk and Risk Group 10 is at highest risk.

Process for Calculating Risk-Adjusted Post-Op Stroke Rate and Performance Ratings The risk-adjusted post-operative stroke rate (RASR) is computed by dividing the provider’s number of patient strokes by the provider’s expected number of patient strokes (based on the risk model) to obtain the observed/expected (O/E) ratio. The O/E ratio is then multiplied by the statewide post-operative stroke rate (1.28% for 2013-2014) to obtain the provider’s RASR. The performance rating is based on a comparison of the 95% confidence interval (CI) of each provider’s RASR to the statewide post-operative stroke rate. Thus, CCORP treated 2013-2014 data as a sample, and inferred the range in which each provider’s true performance was likely to fall. As shown in Table E-3, if the upper 95% CI of a provider’s risk-adjusted stroke rate is below the state average stroke rate, indicating the provider’s RASR is significantly lower than the state average, the performance rating is “Better.” If the lower 95% CI of a provider’s RASR is above the state average stroke rate, indicating the provider’s risk-adjusted stroke rate is significantly higher than the state average, the performance rating is “Worse.” If the state average stroke rate is within the 95% CI of a provider’s RASR, the performance rating is “Average.” See the following section for a detailed discussion of results.

Hospital Risk-Adjusted Post-Operative Stroke Results, 2013-2014 Table E-3 presents the risk-adjusted post-operative stroke results for each hospital for 2013-2014. The table is sorted by geographic region and contains, for each hospital, the total number of CABG surgeries performed (isolated and non-isolated combined), number of isolated CABG surgeries (excluding salvage cases), number of observed isolated CABG post-operative stroke cases, observed post-operative stroke rate, expected post-operative stroke rate predicted by the risk model, RASR and 95% CI of the RASR, and the associated hospital performance rating. Among the 24,092 isolated CABG surgeries performed in 2013-2014, 308 patients had a post-operative stroke in-hospital, reflecting overall statewide rate of 1.28%. Among 308 patients with post-operative stroke, 52 (14.5%) died either in-hospital or after discharge but within 30 days


102

of CABG surgery. The observed stroke rate among hospitals ranged from 0% to 5.88%. The expected stroke rates, which are generated by the model and measure patient severity of illness, were between 0.746% and 2.25%. The risk-adjusted stroke rates ranged from 0% to 4.36%. Based on the 95% confidence intervals for risk-adjusted stroke rates, 124 of 127 hospitals (96%) performed within the expected range compared to the state’s average stroke rate, one hospital performed significantly “Better” than the state average (St. Bernardine Medical Center), and two hospitals were rated significantly “Worse” than the state average (Sharp Memorial Hospital5 and Shasta Regional Medical Center) (Table E-3).

5 †CCORP provided each hospital with a preliminary report containing the risk-adjusted models, explanatory materials, and results for all hospitals. Hospitals were given a 60-day review period to submit statements to CCORP for inclusion in this report. A statement from Sharp Memorial Hospital is available in Appendix C


103

Table E-3: Hospital Risk-Adjusted Post-Operative Stroke Results by Region, 2013-2014

Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG Post-

Operative Strokes

Observed Post-

Operative Stroke Rate (%)

Expected Post-


Risk- Adjusted

Post- Operative

Stroke Rate

(%, RASR)

95%CI for RASR

Performance Rating*

State 31,261 24,092 308 1.28



Mercy General Hospital 1,353 849 10 1.18 1.25 1.21 (0.58, 2.22) Average




Shasta Regional Medical Center 153 136 5 3.68 1.08 4.36 (1.41, 10.17) Worse






293 236 0 0.00 1.20 0.00 (0.00, 1.66) Average



Dominican Hospital – Santa Cruz/Soquel 168 127 1 0.79 1.20 0.84 (0.02, 4.68) Average



104

Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG Post-

Operative Strokes

Observed Post-


Expected Post-


Risk- Adjusted

Post- Operative

Stroke Rate

(%, RASR)

95%CI for RASR

Performance Rating*

State 31,261 24,092 308 1.28




John Muir Medical Center – Walnut Creek Campus 1 . . . . . (., .) Not

Applicable

Kaiser Foundation Hospital – San Francisco 814 643 12 1.87 1.11 2.16 (1.11, 3.77) Average












105

Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG Post-

Operative Strokes

Observed Post-


Expected Post-


Risk- Adjusted

Post- Operative

Stroke Rate

(%, RASR)

95%CI for RASR

Performance Rating*

State 31,261 24,092 308 1.28












Central California



Community Regional Medical Center – Fresno 521 433 4 0.92 1.42 0.83 (0.23, 2.14) Average





106

Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG Post-

Operative Strokes

Observed Post-


Expected Post-


Risk- Adjusted

Post- Operative

Stroke Rate

(%, RASR)

95%CI for RASR

Performance Rating*

State 31,261 24,092 308 1.28







St. Agnes Medical Center 568 452 4 0.88 1.20 0.94 (0.26, 2.42) Average

St. Joseph's Medical Center of Stockton 503 415 4 0.96 1.58 0.78 (0.21, 2.00) Average







Los Robles Hospital & Medical Center 185 139 4 2.88 1.46 2.52 (0.69, 6.45) Average


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Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG Post-

Operative Strokes

Observed Post-


Expected Post-


Risk- Adjusted

Post- Operative

Stroke Rate

(%, RASR)

95%CI for RASR

Performance Rating*

State 31,261 24,092 308 1.28



Palmdale Regional Medical Center 18 18 0 0.00 1.34 0.00 (0.00, 19.50) Average





St. John's Regional Medical Center 176 139 5 3.60 1.46 3.15 (1.02, 7.36) Average


West Hills Regional Medical Center 109 95 2 2.11 1.93 1.40 (0.17, 5.04) Average

Greater Los Angeles






108

Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG Post-

Operative Strokes

Observed Post-


Expected Post-


Risk- Adjusted

Post- Operative

Stroke Rate

(%, RASR)

95%CI for RASR

Performance Rating*

State 31,261 24,092 308 1.28









Kaiser Foundation Hospital – Sunset 1,426 1085 10 0.92 1.29 0.91 (0.44, 1.68) Average






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Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG Post-

Operative Strokes

Observed Post-


Expected Post-


Risk- Adjusted

Post- Operative

Stroke Rate

(%, RASR)

95%CI for RASR

Performance Rating*

State 31,261 24,092 308 1.28



224 177 1 0.56 0.89 0.81 (0.02, 4.51) Average


Presbyterian Intercommunity Hospital 261 118 1 0.85 1.41 0.77 (0.02, 4.27) Average

Providence Little Company of Mary Hospital Medical Center – Torrance

247 171 1 0.58 1.41 0.53 (0.01, 2.95) Average


Saint John's Health Center 113 82 2 2.44 1.24 2.51 (0.30, 9.07) Average







Desert Regional Medical Center 265 215 0 0.00 1.19 0.00 (0.00, 1.85) Average


Eisenhower Medical Center 319 254 3 1.18 1.34 1.13 (0.23, 3.30) Average


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Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG Post-

Operative Strokes

Observed Post-


Expected Post-


Risk- Adjusted

Post- Operative

Stroke Rate

(%, RASR)

95%CI for RASR

Performance Rating*

State 31,261 24,092 308 1.28

Inland Empire, Riverside & San Bernardino (continued)







St. Bernardine Medical Center 1049 886 3 0.34 1.17 0.37 (0.08, 1.08) Better


Temecula Valley Hospital 16 15 0 0.00 1.14 0.00 (0.00, 27.50) Average

Orange County



232 215 7 3.26 1.39 3.00 (1.20, 6.17) Average




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Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG Post-

Operative Strokes

Observed Post-


Expected Post-


Risk- Adjusted

Post- Operative

Stroke Rate

(%, RASR)

95%CI for RASR

Performance Rating*

State 31,261 24,092 308 1.28

Orange County (continued)









Greater San Diego





Scripps Memorial Hospital – La Jolla 698 482 2 0.41 1.15 0.46 (0.06, 1.66) Average




112

Region Hospital All

CABG Cases

Isolated CABG Cases

Isolated CABG Post-

Operative Strokes

Observed Post-


Expected Post-


Risk- Adjusted

Post- Operative

Stroke Rate

(%, RASR)

95%CI for RASR

Performance Rating*

State 31,261 24,092 308 1.28


Sharp Memorial Hospital† 364 226 8 3.54 1.06 4.27 (1.84, 8.41) Worse


UC San Diego Health – Sulpizio Cardiovascular Center 288 170 0 0.00 1.17 0.00 (0.00, 2.37) Average

*A hospital is classified as “Better” if the upper 95% CI of the RASR falls below the California observed stroke rate (1.28%). A hospital is classified as “Worse” if the lower 95% CI of the RASR is higher than the California observed stroke rate. A hospital’s performance is considered “Average” if the California stroke rate falls within the 95% CI of a hospital’s RASR.

† Hospitals submitted statements regrding this report. See Appendix C for their statements


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Hospital Internal Mammary Artery Usage Results, 2014 A widely accepted definition of healthcare quality contains three dimensions: process, structure, and outcomes.6 In addition to publishing hospital outcomes, this report also assesses a process of care measure by reporting hospital use of the internal mammary artery (IMA) in surgery. Although outcomes measurement permits comparison of provider performance and can be used for investigating internal processes and structures, assessing the process of care provides a more immediate path to improved care since it measures a specific step in patient care. If diagnostic and therapeutic strategies with clear links to outcomes are monitored, some healthcare quality problems can be detected and ameliorated long before demonstrable health outcomes occur. In most cases of first-time isolated CABG surgery where the operative status is elective or urgent, the surgeon has the option of using the IMA (also known as the internal thoracic artery). Clinical literature strongly supports use of the IMA to promote long-term graft patency (durability) and patient survival. Research also suggests a reduction in immediate operative mortality associated with use of the internal mammary artery rather than saphenous (leg) vein revascularization.7 The IMA, and especially the left IMA, is considered the preferred conduit for CABG surgery of the LAD coronary artery. Many nationally respected organizations encourage the use of IMA when appropriate. Currently, the Leapfrog Evidence-Based Hospital Referral program endorses the goal of 80% hospital adherence to IMA use. The NQF does not endorse a specific rate but states that the goal is to raise the IMA usage rates of hospitals with low utilization. The STS states that IMA use should be given primary consideration in every CABG surgery patient. Furthermore, a number of healthcare quality advocates recommend public reporting of IMA usage rates for CABG surgery. Table G-1 presents hospital results by region for usage of the IMA during 2014. Only first-time isolated CABG surgeries where the operative status is elective or urgent and the LAD was bypassed are included in calculating IMA usage rates. The statewide IMA usage rate was virtually unchanged (96.6% in 2013 vs. 97.1% in 2014). Three hospitals received a “Low” rating for 2014 (Antelope Valley Hospital, Palmdale Regional Medical Center, and Shasta Regional Medical Center). Two of these hospitals, historically have had poor IMA usage rates. Palmdale Regional Medical Center was rated “Low” in 2013 and 2014. Antelope Valley Hospital was rated “Low” in 2009, 2010, 2012, 2013, and 2014. Hospital IMA usage rates above the statewide average rate are not rated because there is no consensus on what constitutes an optimal IMA usage rate.

Definitions of Table F-1 Terms

Isolated CABG Surgeries: Includes only first-time, non-cardiogenic shock, isolated CABG surgeries for 2014 where the operative status was elective or urgent and the LAD artery was bypassed. This number is usually smaller than the total isolated CABG cases performed by the hospital.

IMA Usage Rate: The ratio of the number of CABG surgeries with IMA grafts (including left IMA, right IMA, and bilateral IMA) and selected first-time isolated CABG cases multiplied by

6 Donabedian A. Evaluating the Quality of Medical Care. The Milbank Quarterly, 2005; 83(4):691-729. 7 Ferguson TB Jr, Coombs LP, Peterson ED. “Internal thoracic artery grafting in the elderly patient undergoing coronary artery bypass grafting: room for process improvement?” Journal of Thoracic and Cardiovascular Surgery, 2002; 123(5):869-80.


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100: Percent IMA use = Number of IMA Grafts used for First-Time Isolated CABG Surgeries/Number of First-Time Isolated CABG Cases × 100. Performance Rating: A blank rating indicates that the IMA usage rate is acceptable. A “Low” rating indicates that the IMA usage rate for a hospital is less than 84.22%, i.e., two standard deviations (0.0657 x 1.96) below the hospital statewide average IMA usage rate (97.1%). IMA usage rates above the hospital statewide average IMA usage rate were not evaluated because there is no consensus on what constitutes an optimal rate of usage.

Table F1: Hospital Internal Mammary Artery Usage Results by Region, 2014

Region Hospital Isolated CABGs*

Percent IMA Use Rank**

State All Hospitals 11,043 97.10% Sacramento Valley & Northern California Region

Enloe Medical Center – Esplanade Campus 112 96.43% Acceptable Mercy General Hospital 396 99.75% Acceptable Mercy Medical Center – Redding 91 100.00% Acceptable Mercy San Juan Hospital 79 100.00% Acceptable Rideout Memorial Hospital 76 100.00% Acceptable Shasta Regional Medical Center 52 80.77% Low St. Joseph Hospital – Eureka 15 100.00% Acceptable Sutter Memorial Hospital 290 98.28% Acceptable UC Davis Medical Center 78 100.00% Acceptable


Alta Bates Summit Medical Center – Summit Campus 114 100.00% Acceptable

California Pacific Medical Center – Pacific Campus 53 96.23% Acceptable Community Hospital Monterey Peninsula 81 100.00% Acceptable Dominican Hospital – Santa Cruz/Soquel 62 100.00% Acceptable El Camino Hospital 79 96.20% Acceptable Good Samaritan Hospital – San Jose 66 100.00% Acceptable John Muir Medical Center – Concord Campus 188 100.00% Acceptable Kaiser Foundation Hospital – San Francisco 287 98.61% Acceptable Kaiser Foundation Hospital – Santa Clara 245 99.59% Acceptable Marin General Hospital 30 96.67% Acceptable North Bay Medical Center 34 100.00% Acceptable O’Connor Hospital – San Jose 32 100.00% Acceptable Peninsula Medical Center 45 97.78% Acceptable Queen Of The Valley Hospital – Napa 31 100.00% Acceptable Regional Medical of San Jose 62 98.39% Acceptable Salinas Valley Memorial Hospital 92 98.91% Acceptable San Ramon Regional Medical Center 21 100.00% Acceptable Santa Clara Valley Medical Center 67 100.00% Acceptable Santa Rosa Memorial Hospital – Montgomery 57 96.49% Acceptable Sequoia Hospital 50 98.00% Acceptable


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Table F1: Hospital Internal Mammary Artery Usage Results by Region, 2014

Region Hospital Isolated CABGs*

Percent IMA Use Rank**

State All Hospitals 11,043 97.10% San Francisco Bay Area & San Jose (continued)

Seton Medical Center 46 91.30% Acceptable St. Helena Hospital 75 96.00% Acceptable St. Mary's Medical Center, San Francisco 18 100.00% Acceptable Stanford Hospital 89 96.63% Acceptable Sutter Santa Rosa Regional Hospital 46 95.65% Acceptable UC San Francisco Medical Center 63 100.00% Acceptable Valleycare Medical Center 20 100.00% Acceptable Washington Hospital – Fremont 81 100.00% Acceptable

Central California

Bakersfield Heart Hospital 46 89.13% Acceptable Bakersfield Memorial Hospital 113 95.58% Acceptable Community Regional Medical Center – Fresno 196 98.98% Acceptable Dameron Hospital 47 95.74% Acceptable Doctors Medical Center 215 98.14% Acceptable Emanuel Medical Center 67 98.51% Acceptable Fresno Heart And Surgical Hospital 119 99.16% Acceptable Kaweah Delta Medical Center 152 99.34% Acceptable Marian Medical Center 50 100.00% Acceptable Memorial Hospital Medical Center – Modesto 135 91.11% Acceptable San Joaquin Community Hospital 68 95.59% Acceptable St. Agnes Medical Center 193 100.00% Acceptable St. Joseph's Medical Center of Stockton 200 98.50% Acceptable


Antelope Valley Hospital 15 73.33% Low Community Memorial Hospital – San Buenaventura 67 100.00% Acceptable French Hospital Medical Center 74 97.30% Acceptable Glendale Adventist Medical Center – Wilson Terrace 89 98.88% Acceptable

Glendale Memorial Hospital And Health Center 114 99.12% Acceptable Los Robles Hospital & Medical Center 54 100.00% Acceptable Northridge Hospital Medical Center 77 98.70% Acceptable Palmdale Regional Medical Center 8 37.50% Low Providence Holy Cross Medical Center 34 100.00% Acceptable Providence Saint Joseph Medical Center 45 97.78% Acceptable Providence Tarzana Medical Center 50 98.00% Acceptable Santa Barbara Cottage Hospital 83 100.00% Acceptable St. John's Regional Medical Center 80 97.50% Acceptable Valley Presbyterian Hospital 40 100.00% Acceptable West Hills Regional Medical Center 43 100.00% Acceptable


116

Greater Los Angeles

Beverly Hospital 11 100.00% Acceptable California Hospital Medical Center – Los Angeles 19 94.74% Acceptable Cedars Sinai Medical Center 117 98.29% Acceptable Centinela Hospital Medical Center 27 96.30% Acceptable Citrus Valley Medical Center – Inter Community Campus 103 96.12% Acceptable

Downey Regional Medical Center 45 88.89% Acceptable Garfield Medical Center 96 95.83% Acceptable Good Samaritan Hospital – Los Angeles 77 100.00% Acceptable Henry Mayo Newhall Memorial Hospital 31 93.55% Acceptable Hollywood Presbyterian Medical Center 41 97.56% Acceptable Huntington Memorial Hospital 61 98.36% Acceptable Kaiser Foundation Hospital – Sunset 539 99.07% Acceptable Keck Hospital of University of Southern California 61 98.36% Acceptable Lakewood Regional Medical Center 81 91.36% Acceptable Long Beach Memorial Medical Center 146 95.21% Acceptable Los Angeles County/Harbor – UCLA Medical Center 64 98.44% Acceptable Los Angeles County/University of Southern California Medical Center 78 98.72% Acceptable

Methodist Hospital of Southern California 49 93.88% Acceptable Presbyterian Intercommunity Hospital 49 97.96% Acceptable Providence Little Company of Mary Hospital Medical Center – Torrance 86 94.19% Acceptable

Ronald Reagan UCLA Medical Center 96 95.83% Acceptable Saint John's Health Center 37 97.30% Acceptable St. Francis Medical Center 23 86.96% Acceptable St. Mary Medical Center – Long Beach 32 96.88% Acceptable St. Vincent Medical Center – Long Beach 46 100.00% Acceptable Torrance Memorial Medical Center 46 100.00% Acceptable White Memorial Medical Center 37 100.00% Acceptable


Desert Regional Medical Center 104 96.15% Acceptable Desert Valley Hospital 33 100.00% Acceptable Eisenhower Medical Center 111 100.00% Acceptable Kaiser Foundation Hospital – Fontana 49 97.96% Acceptable Loma Linda University Medical Center 145 98.62% Acceptable Loma Linda University Medical Center – Murrieta 95 95.79% Acceptable Pomona Valley Hospital Medical Center 118 98.31% Acceptable Riverside Community Hospital 142 97.18% Acceptable San Antonio Community Hospital 110 97.27% Acceptable St. Bernardine Medical Center 412 99.03% Acceptable St. Mary Medical Center – Apple Valley 63 100.00% Acceptable Temecula Valley Hospital 15 93.33% Acceptable


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Orange County

AHMC Anaheim Regional Medical Center 123 97.56% Acceptable Fountain Valley Regional Hospital and Medical Center – Euclid 110 89.09% Acceptable

Hoag Memorial Hospital Presbyterian 122 100.00% Acceptable Mission Hospital Regional Medical Center 104 99.04% Acceptable Orange Coast Memorial Medical Center 57 100.00% Acceptable Saddleback Memorial Medical Center 65 100.00% Acceptable St. Joseph Hospital – Orange 22 100.00% Acceptable St. Jude Medical Center 72 100.00% Acceptable UC Irvine Medical Center 68 97.06% Acceptable West Anaheim Medical Center 19 100.00% Acceptable Western Medical Center – Anaheim 30 100.00% Acceptable Western Medical Center – Santa Ana 82 100.00% Acceptable

Greater San Diego

Alvarado Hospital 24 100.00% Acceptable Grossmont Hospital 103 100.00% Acceptable Palomar Health Downtown Campus 41 90.24% Acceptable Scripps Green Hospital 44 100.00% Acceptable Scripps Memorial Hospital – La Jolla 235 100.00% Acceptable Scripps Mercy Hospital 92 100.00% Acceptable Sharp Chula Vista Medical Center 79 100.00% Acceptable Sharp Memorial Hospital† 97 97.94% Acceptable Tri-City Medical Center – Oceanside 74 97.30% Acceptable UC San Diego Health – Sulpizio Cardiovascular Center 88 100.00% Acceptable

* Only includes first-time non-cardiogenic shock isolated CABGs where the operative status was elective or urgent. Cases where LAD was not by-passed or not by-passable were excluded.

** Low Rank: IMA usage rate for a hospital is less than 84.22%, i.e. two standard deviations (0.0657x1.96) below the hospital statewide average IMA


118

Appendix A: Definition of Terms

All CABG Cases: The total number of isolated and non-isolated CABG cases submitted to CCORP. To improve statistical reliability, some measures combine data from two years.

Hospital Operative Mortality: 2014 Hospital Post-Operative Stroke: 2013-2014 Surgeon Operative Mortality: 2013 and 2014

Non-isolated CABG cases are excluded from the performance rating calculations. Isolated CABG Cases: The number of isolated CABG cases submitted to CCORP during the time period indicated for the outcome listed above. All patients in salvage operative status are excluded from the isolated CABG cases, thus only isolated CABG cases without salvage operative status are used to calculate performance ratings. CABG + Valve Cases: The number of CABG cases performed that included aortic valve replacement, mitral valve repair or replacement or a combination thereof. Responsible Surgeon: The principle surgeon who performs a CABG procedure. In situations in which a responsible surgeon cannot otherwise be determined, the responsible surgeon is the surgeon who bills for the procedure. Isolated CABG Outcomes:

Operative Mortality (hospital and surgeon): The number of operative deaths for isolated CABG cases for the time period indicated. The number of deaths includes 1) all deaths that occur during the hospitalization in which the CABG surgery was performed, including those occurring after 30 days; and 2) all deaths occurring within 30 days after the CABG surgery (2014 data). Post-Operative Strokes: The number of post-operative strokes that were unresolved after 24 hours for isolated CABG cases for the time period indicated (2013-2014 data).

CABG + Valve Outcome: Operative Mortality: The number of operative deaths for CABG + valve cases for the time period indicated. CABG + Valve cases are defined as CABG surgery with aortic valve replacement, mitral valve repair or replacement or a combination thereof. The number of deaths includes 1) all deaths that occur during the hospitalization in which the CABG surgery was performed, including those occurring after 30 days; and 2) all deaths occurring within 30 days after the CABG surgery (2013-2014 data).

Observed CABG Outcome Rate: The ratio of the number of (isolated or +valve) CABG cases with an outcome (operative deaths or post-operative strokes) and the number of (isolated or +valve) CABG cases multiplied by 100: Observed Outcome Rate (operative death or post-operative stroke) = Isolated CABG Cases with Outcome/Isolated CABG Cases × 100. Expected CABG Outcome Rate: The ratio of the expected number of outcomes (operative deaths or post-operative strokes) predicted for a provider (after risk adjusting for the provider’s patient population) and the number of isolated CABG cases multiplied by 100: Expected CABG Outcome Rate = Expected CABG Outcomes/Isolated CABG Cases × 100.


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Risk-Adjusted Outcome Rate (95% CI): The risk-adjusted outcome rate (Mortality Rate [RAMR] and Post-Operative Stroke Rate [RASR]) is obtained by multiplying the California observed CABG outcome rate by the provider's relevant Observed/Expected ratio. The 95% confidence interval represents the confidence we have in the estimate for the risk-adjusted rate. The lower and upper confidence limits are calculated using Poisson exact confidence interval calculations. Performance Rating: The performance rating is based on a comparison of each provider's risk-adjusted outcome rate and the California observed outcome rate. This is a test of statistical significance. A provider is classified as "Better" if the upper 95% confidence limit of its rate falls below the California observed rate. A provider is classified as "Worse" if the lower 95% confidence limit of its outcome rate is higher than the California observed rate. A provider is classified as "Average" if the California outcome rate falls within the confidence interval of the provider's risk-adjusted outcome rate.


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Appendix B: Hospital Statements

CCORP provided each hospital with a preliminary report containing the risk-adjusted models, explanatory materials, and results for all hospitals. Hospitals were given a 60-day review period to submit statements to CCORP for inclusion in this report. One hospital submitted a statement, which is included here.


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122

Appendix D: Acknowledgments

The California Coronary Artery Bypass Graft (CABG) Outcomes Reporting Program (CCORP) is funded by the Office of Statewide Health Planning and Development’s California Health Data and Planning Fund.

This report represents the contributions of many individuals. Hospital staff dedicated time and resources to collect, report, and review the data for analysis. Hospitals provided ongoing feedback on the design of the program, which is vital to its success, and members of the CCORP Clinical Advisory Panel provided oversight and policy guidance for data collection and analysis. The Healthcare Information Division and the Healthcare Information Resource Center within the division provided expertise in report concept, editing, and design. The California Department of Public Health provided Vital Statistics files needed for identifying post-surgery deaths after discharge. CCORP also benefited from collaboration with the Society of Thoracic Surgeons and its California Chapter to coordinate and improve data quality.

CCORP reflects the efforts and significant contributions of the following individuals:

Office of Statewide Health Planning and Development

University of California, Davis Study Consultants

Ronald A. Spingarn, M.S. Former Deputy Director, Healthcare Information Division

Banafsheh Sadeghi, M.D., Ph.D. Principal Investigator

Joseph P. Parker, Ph.D. Former Manager, Healthcare Outcomes Center

Zhongmin Li, Ph.D. Co-Investigator

Chris Krawczyk, Ph.D. Manager, Healthcare Analytics Branch

Beate Danielsen, Ph.D. Co-Investigator

Holly Hoegh, Ph.D. Manager, Clinical Data Unit

Geeta Mahendra, M.A., M.S. Senior Programmer

Denise Stanton Clinical Data Manager

Dominique Ritley, M.P.H. Project Analyst

Robert Springborn, Ph.D. Research Scientist

Lisa (Cook) Christensen Contracts Manager

Project Advisors

Ezra Amsterdam, M.D. Richard White, M.D. Patrick Romano, M.D., M.P.H. University of California, Davis

Anthony E. Steimle, M.D., F.A.C.C. Kaiser Foundation Hospital – Santa Clara

OSHPD Student Assistants

Mariah Baker Mia DeSoto

Alysha Lal


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California CABG Outcomes Reporting Program (CCORP) 2013-2014 Clinical Advisory Panel

Chair

Ralph G. Brindis, M.D., M.P.H., F.A.C.C. Clinical Professor of Medicine Department of Medicine & the Philip R. Lee Institute for Health Policy Studies University of California, San Francisco

Members Cheryl L. Damberg, Ph.D. Research Director, RAND Corporation Santa Monica

Gordon L. Fung, M.D., M.P.H., Ph.D. Health Sciences Clinical Professor UCSF School of Medicine San Francisco

Hon S. Lee, M.D. The Permanente Medical Group Cardiovascular Surgery Santa Clara

James MacMillan, M.D. Valley Heart Surgeons Modesto

Rita Redberg, M.D. Division of Cardiology University of California, San Francisco

Maribeth Shannon, M.S. Oakland

Richard Shemin, M.D. Director of Cardiac Surgery Ronald Reagan UCLA Medical Center Los Angeles

J. Nilas Young, M.D. Division of Cardiothoracic Surgery UC Davis Medical Center Sacramento

Former Panel Member: Andrew B. Bindman, M.D. Professor of Medicine, Health Policy Epidemiology & Biostatistics University of California, San Francisco

technical note for the california report on coronary … citation: state of california, office of...

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