Coronary Artery Bypass Graft Surgery Clinical Quality: A Network-DEA approach

Abstract

Clinical quality, as a technical result quality of health services, is a concept that outlines how health system inputs are transformed into health outcomes. The aim of the study is to develop a model in which the relative clinical quality levels of the patients are evaluated with the Network Data Envelopment Analysis (NDEA) method by using the structure, process, and outcome measures of the Coronary Artery Bypass Graft (CABG) surgery. The research was conducted in a tertiary training and research hospital as a prospective, cross-sectional and registry research. Clinical quality levels of patients who underwent CABG surgery were evaluated with NDEA (two-stage) method in managerial and clinical efficiency stages. NDEA showed that 3 patients had the best clinical quality level. The patient profile with a low clinical quality level was created in managerial and clinical stages and quality improvement points were determined. The NDEA model enabled the analysis of all the structure, process and outcome measures simultaneously and was used to evaluate clinical quality with multiple measures. Using this data, the CABG surgical process profile was created. Intensive care unit (ICU) and postoperative inpatient day, cardiopulmonary bypass (CPB) and cross-clamp (CC) duration, and the use of fresh frozen plasma (FFP) were determined as the CABG surgery points requiring quality improvement.