The improving outcomes of coronary artery bypass graft surgery in
Bibliographic record
Abstract
Background: There is continuing uncertainty over the relative contribution of outcomes monitoring to changes in surgical outcomes over time. The authors studied temporal trends in the clinical characteristics and short-term outcomes of patients who underwent coronary artery bypass grafting (CABG) in Ontario before and after the implementation, in 1993, of a province-wide program to provide feedback on cardiac surgery outcomes. Methods: The authors analysed data from hospital discharge abstracts on the clinical characteristics and in-hospital death rates of all 67 784 patients who underwent isolated CABG in Ontario between Apr. 1, 1981, and Mar. 31, 1996. Results: Death rates were relatively stable during the first half of the 1980s, then declined gradually in the second half of the decade; this decline continued into the first half of the 1990s. In the 1990s patients were older than those in the 1980s, and a higher proportion had coexisting diseases. Between 1986/87 and 1995/96 the unadjusted death rate decreased by 52 % (5.0 % v. 2.4%) (p < 0.001). The annual relative rate of decline was approximately 6 % (95 % confidence interval 5 % to 7%) in the period before the outcomes feedback program was implemented and about 9 % (95 % confidence interval 7 % to 11%) in the period after implementation. Interpretation: Rates of death after CABG have been declining steadily in Ontario since the mid-1980s. Outcomes-based quality improvement interventions may facilitate, but are not a prerequisite for, improvements in the quality of surgical care. Résumé Contexte: L’incertitude règne toujours au sujet de la contribution relative du suivi des résultats à l’évolution chronologique des résultats chirurgicaux. Les auteurs ont étudié les tendances chronologiques des caractéristiques cliniques et des résultats à court terme chez les patients qui ont subi un pontage aortocoronarien (PAC) en Ontario avant et après la mise en œuvre, en 1993, d’un programme provincial de rétroaction sur les résultats des interventions en chirurgie cardiaque. Méthodes: Les auteurs ont analysé des données tirées des résumés de libération d’hôpitaux portant sur les caractéristiques cliniques et les taux de mortalité à l’hôpital des 67 784 patients qui ont subi des PAC isolés en Ontario entre le 1 er
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".