Cardiac Surgery Performance: Quality Performance Measures and Public Reporting
This past year, STS introduced an offshoot of the STS Adult Cardiac Surgery Database called STS Public Reporting Online. Public Reporting Online scores participating hospitals and surgical groups across the nation on the quality of heart bypass surgery, specifically isolated coronary artery bypass grafting (CABG), with a multidimensional composite score. Each provider receives 1, 2, or 3 stars, representing comparative scores that are below average, average, or above average, respectively.
The STS CABG Composite Score is one of 22 quality performance measures that STS generates for its participants on a regular basis. Of the 22 performance measures, 11 are for isolated CABG surgery and contribute to the composite score. The measures include both process and outcome, with all outcomes being adjusted for differences in patient risk. Thus, inherent to the composite score are factors specific to both patient and caregiving, such as patient health/age, complications (morbidities) from surgery, and whether standards of evidence-based care have been followed. For example, were beta blockers given within 24 hours preceding surgery? Was an internal mammary artery used as a part of operative care?
STS groups the underlying 11 measures into 4 domains, gives each a score, and rolls them up into one aggregate called the CABG Composite Score. Also available on Public Reporting Online are the domain scores for risk-adjusted operative mortality, risk-adjusted morbidity, operative care process, and perioperative medications. Each domain score is comprised of different outcome measures. For example, the morbidity domain score is derived from 5 outcome measures for CABG surgeries with complications, such as deep sternal wound and postoperative renal failure. The domain score for perioperative medication is derived from 4 quality performance measures dedicated to assessing whether guidelines for required perioperative medications have been followed, such as administering preoperative beta blockers within 24 hours prior to surgery.
STS participants receive additional process measures for performance on selection, timing and duration of antibiotic prophylaxis. They also receive operative mortality outcome measures for patients undergoing aortic valve replacement (AVR), AVR & CABG, mitral valve (MV) repair, MV repair & CABG, MV replacement, and MV replacement & CABG surgeries.
Clearly at the forefront of today’s climate of increased transparency, STS is setting the standard for public reporting. "I take personal pride in noting the great strides towards transparency that STS has taken with this initiative," says Dr. Lawrence Cohn, cardiac surgeon and Harvard Medical School professor. "However we must all be prepared to make the necessary technology investments to ensure that the data capture and subsequent utilization for quality improvement do not hamper us at the point of care."
STS has taken a comprehensive approach to all factors involved in public reporting, such as the integrity of data sources, linkage to other registries, and interoperability of computerized systems. STS participants can have SCIP data submitted directly to the CMS Physician Quality Reporting System from the STS Adult Cardiac Surgery Database, eliminating the need to double document. STS envisions that its National Database will eventually be linked to various administrative sources such as Medicare fee-for-service claims data and the Social Security Death Master File. This will be an important component of healthcare reform because it permits analysis of long-term patient outcomes as opposed to 30-day survival probabilities. (“Public Reporting of Cardiac Surgery Performance”)
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