Evidence map›Paper›PMID 41946546›Full record

ArticleBMJ open2026

Evaluation of equity in quality improvement for multiarterial grafting in females and patients with low socioeconomic status: retrospective analysis of a statewide collaborative database.

Catherine Wagner, Patricia F Theurer, Melissa Clark, Chang He, Thomas Braun, Fouad Azoury, Hisham G Qandeel, Dimitrios E Magouliotis, James Martin, Andrew Pruitt and 6 more

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Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

16 authors.

Catherine WagnerDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA.ORCID http://orcid.org/0000-0001-7904-1929
Patricia F TheurerCardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan, USA.
Melissa ClarkCardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan, USA.
Chang HeCardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan, USA.
Thomas BraunDepartment of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
Fouad AzouryAscension St John Hospital, Detroit, Michigan, USA.
Hisham G QandeelCardiothoracic Surgery, Sparrow Hospital, Lansing, Michigan, USA.
Dimitrios E MagouliotisCardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan, USA.
James MartinCardiothoracic Surgery, McLaren Port Huron, Port Huron, Michigan, USA.
Andrew PruittCardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan, USA.
Ahmet C TopcuCardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan, USA.
Gorav AilawadiDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Donald S LikoskyDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Michael P ThompsonDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Francis D PaganiDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Robert B HawkinsDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA Robertbh@med.umich.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesQuality collaboratives improve quality of care at the hospital and collaborative levels, but less is understood about how such efforts affect patient-level disparities. This study evaluated how a quality improvement (QI) effort (increasing multiarterial grafting during coronary artery bypass grafting (CABG)) translated into populations which historically receive lower-quality care (females and patients of low socioeconomic status).

designRetrospective cohort study.

settingAll non-federal hospitals in the state of Michigan that perform cardiac surgery and participate in a statewide collaborative database (n=33).

participantsPatients undergoing first-time, isolated CABG receiving at least two bypass grafts from 2011 to 2022 were identified. PRIMARY ENDPOINTS: Association of sex and socioeconomic status with multiarterial grafting was evaluated across the study period. The distressed community index (DCI), a socioeconomic ranking (0-not distressed, 100-severely distressed), was matched to the patient's zip code. Hierarchical regression modelling was performed to associate DCI and sex with multiarterial grafting, incorporating patient factors and hospital and surgeon effects. A sex-surgery year and DCI-surgery year interaction term was performed to assess the change in the rate of multiarterial grafting.

resultsA total of 40 322 patients underwent CABG at 33 centres with a median age of 66 years and 24% were female. The rate of multiarterial grafting was 15%, although lower among females (10% vs 17%) and the highest (vs lowest) DCI quartile (14% vs 18%). After risk adjustment, females were less likely to receive multiarterial grafting (OR

conclusionsDespite a large overall increase in multiarterial grafting due to QI efforts, females and patients with low socioeconomic status had lower rates of multiarterial grafting. QI efforts should be evaluated both overall and among patients who historically receive lower quality care to improve quality and equity.

Indexed as

Coronary Artery BypassHealthcare DisparitiesQuality ImprovementAgedDatabases, FactualFemaleHumansLow Socioeconomic StatusMaleMichiganMiddle AgedRetrospective StudiesSex FactorsSocial ClassSocioeconomic Disparities in HealthCardiac surgeryHealth EquityQuality ImprovementSURGERY

Identifiers

PMID41946546
PMCPMC13064146

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