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Quality Initiatives at STS

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Title: Quality Initiatives at STS


1
Quality Initiatives at STS
  • Cynthia M. Shewan, PhD
  • Director, Quality, Research and Patient Safety
  • The Society of Thoracic Surgeons
  • NSQIP Conference
  • June 26, 2007

2
Quality Initiatives at STS
  • Many quality initiatives stem from STSs National
    Database
  • 3 Components
  • Adult Cardiac Surgery
  • General Thoracic Surgery
  • Congenital Heart Surgery

3
Adult Cardiac Surgery Database
  • Inception 1989
  • 826 active participants
  • 3 Million surgical procedures
  • 2 data harvests/yr.
  • 286 harvested data fields
  • Focused on CABG and Valve Replacement/Repair

4
General Thoracic Surgery Database
  • Inception 2002
  • 63 active participants
  • 49,150 surgical procedures recorded
  • 1 data harvest /yr.
  • 140 harvested data fields
  • Focused on Lung and Esophageal Cancer

5
Congenital Heart Surgery Database
  • Inception 2002
  • 63 active participants
  • 71,385 surgical procedures submitted
  • 1 data harvest/yr.
  • 84 harvested data fields
  • Focused on 9 Specific Lesions

6
Basis for Measuring Quality
  • 21 NQF-endorsed adult cardiac measures
  • Structural
  • Volume
  • Process
  • Use of Internal Mammary Artery (IMA)
  • Outcomes
  • Risk-adjusted Operative Mortality

7
Basis for Measuring Quality
  • 6 provisional general thoracic measures
  • Approved by AQA
  • 26 congenital heart surgery measures
  • Submitted to NQF for endorsement

8
Adult Cardiac Quality Initiatives
  • STS Database collects data on 17 of the NQF
    measures
  • Focus on process and outcomes measures

9
NQF Measures
10
Composite Quality Score
  • Establishment of Quality Measurement Task Force
  • Quality Indicators selected on several
    principles, including IOM criteria, from 21
    NQF-endorsed measures
  • CABG only
  • Selected 11 measures

11
Composite Quality Score
  • 4 quality of care domains
  • Operative Care
  • Perioperative Medical Care
  • Risk-adjusted Mortality
  • Risk-adjusted Major Morbidity
  • All 4 domain scores contribute to overall quality
    score
  • Quality score converted to performance tiers

12
Composite Quality Score
13
Composite Quality Score
  • Assigned to middle tier () if score was
    indistinguishable from STS national average,
    based on 99 Bayesian certainty criterion
  • Assigned to bottom tier () if score was lower
    than STS national average, based on 99 Bayesian
    certainty criterion

14
Composite Quality Score
  • Assigned to top tier () if score was higher
    than STS national average, based on 99 Bayesian
    certainty criterion
  • Quality Measurement in Adult Cardiac Surgery.
    The Annals of Thoracic Surgery. Vol. 83, No. 4,
    April 2007 Supplement.

15
Quality with 3rd Parties
  • Collaborating with 3rd Parties
  • Quality Measurement Advisory Committee
  • Representatives from several organizations
  • Provide input on quality measurement
  • STS representatives on 3rd party quality groups

16
Quality with 3rd Parties
  • 3 Tier Approach to Quality
  • Aggregate Level Reports
  • STS Overall
  • State/Regional
  • Individual Participant/hospital Level Reports
  • 3 Star Rating System

17
Reporting Performance
  • Type of Reporting Program
  • Voluntary
  • Mandated
  • Level of Reporting
  • Surgeon Group/Hospital
  • Individual Surgeon
  • Recipient of Report
  • Private Sector
  • Government

18
Reporting Performance
  • Type of Data
  • Clinical
  • Administrative
  • Use of Reported Data
  • Recognition
  • Financial Reward/Pay for Performance

19
Pay for Performance
  • STS advocates a phased in approach
  • Pay for participation
  • Pay for improvement
  • Pay for performance
  • STS Education about PQRI
  • CMS initiative
  • Replacement for PVRP
  • Prepare CT surgeons to report measures

20
Pay for Performance
  • Have adult cardiac measures
  • Goal to have CMS directly accept data from STS
    database in 2008
  • General thoracic measures under perioperative
    care measures

21
New Quality Initiatives
  • 1. Addition of Unique Identifiers to Databases
  • Level of Identifier
  • Patient level
  • Physician level
  • Hospital level
  • Facilitates linking among STS databases and with
    external databases

22
New Quality Initiatives
  • 2. Link STS Database with Other Databases
  • Link STS clinical data with CMS administrative
    (e.g., billing) data
  • Link STS clinical data with 3rd party payer
    longitudinal data
  • Look at long term outcomes
  • Apply knowledge of positive outcomes
    prospectively
  • Link STS with National Death Index (NDI) Social
    Security Death Index
  • Enables longitudinal follow-up

23
New Quality Initiatives
  • 3. Addition of Modules to Core AC Database
  • Web-based data collection reporting
  • Link to core via Record ID number
  • Circumscribed clinical area
  • E.g., Atrial Fibrillation
  • More nimble operationally
  • Easily changed

24
New Quality Initiatives
  • 4. New Version (2.6) Adult Cardiac Database
  • Revision of current variables, as necessary
  • Addition of new variables
  • Harmonization of common variables with American
    College of Cardiology (ACC)

25
New Quality Initiatives
  • 5. Addition of Participants from Another
    Specialty
  • Congenital Cardiac Anesthesia Society (CCAS)
  • Pediatric anesthesiologists

26
Quality Improvement Activity
  • Randomized Clinical Trial
  • Secondary Prevention and CABG A Society-Led
    RCT
  • T. Bruce Ferguson, Jr., MD, PI
  • Determined that feedback improved performance

27
Quality Improvement Activity
  • Regional Groups
  • Michigan Quality Improvement Project funded by
    Blue Cross Blue Shield (BCBS)
  • Virginia Cardiac Surgery Quality Initiative
    (VCSQI)
  • 12 Regional Groups

28
Shaping Future of Quality
  • STS taking proactive role
  • Surgeons better than anyone else know how to
    measure quality
  • STS surgeons have assumed leadership positions in
    major quality organizations
  • NQF (National Quality Forum)
  • AQA
  • SQA (Surgical Quality Alliance)

29
Shaping Future of Quality
  • PCPI (Physician Consortium for Quality
    Improvement)
  • STS surgeons serving on 3rd party quality boards
  • United HealthCare
  • Blue Cross Blue Shield Association

30
Shaping Future of Quality
  • Strong Advocacy Presence in Washington, DC
  • Need to use clinical data
  • Focus on participation, improvement, performance
  • Testify before Congress

31
Quality Initiatives at STS
  • Thank you
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