Comparison of Pediatric Cardiac Surgical Mortality Rates From National Administrative Data to Contemporary Clinical Standards
|
|
- Solomon Daniel
- 5 years ago
- Views:
Transcription
1 Comparison of Pediatric Cardiac Surgical Mortality Rates From National Administrative Data to Contemporary Clinical Standards Karl F. Welke, MD, Brian S. Diggs, PhD, Tara Karamlou, MD, MS, and Ross M. Ungerleider, MD, MBA Division of Cardiothoracic Surgery and Department of Surgery, Oregon Health and Science University, Portland, Oregon; and Section of Cardiac Surgery, University of Michigan, School of Medicine, Ann Arbor, Michigan Background. Despite the superior coding and risk adjustment of clinical data, the ready availability, national scope, and perceived unbiased nature of administrative data make it the choice of governmental agencies and insurance companies for evaluating quality and outcomes. We calculated pediatric cardiac surgery mortality rates from administrative data and compared them with widely quoted standards from clinical databases. Methods. Pediatric cardiac surgical operations were retrospectively identified by ICD-9-CM diagnosis and procedure codes from the Nationwide Inpatient Sample (NIS) and the Kids Inpatient Database (KID) Cases were grouped into Risk Adjustment for Congenital Heart Surgery, version 1 (RACHS-1) categories. In-hospital mortality rates and 95% confidence intervals were calculated. Results. A total of 55,164 operations from the NIS and 10,945 operations from the KID were placed into RACHS-1 categories. During the 18-year period, the overall NIS mortality rate for pediatric cardiac surgery decreased from 8.7% (95% confidence interval, 8.0% to 9.3%) to 4.6% (95% confidence interval, 4.3% to 5.0%). Mortality rates by RACHS-1 category decreased significantly as well. The KID and NIS mortality rates from comparable years were similar. Overall mortality rates derived from administrative data were higher than those from contemporary national clinical data, The Society of Thoracic Surgeons Congenital Heart Surgery Database, or published data from pediatric cardiac specialty centers. Although category-specific mortality rates were higher in administrative data than in clinical data, a minority of the relationships reached statistical significance. Conclusions. Despite substantial improvement, mortality rates from administrative data remain higher than those from clinical data. The discrepancy may be attributable to several factors: differences in database design and composition, differences in data collection and reporting structures, and variation in data quality. (Ann Thorac Surg 2009;87:216 23) 2009 by The Society of Thoracic Surgeons As medicine enters the pay for performance era, governmental agencies, insurance companies, and consumer groups are increasingly interested in measuring the quality of pediatric cardiac surgery programs. Despite the superior coding and risk adjustment of clinical data, the ready availability, national scope, and perceived unbiased nature of administrative data make it the choice of these parties for evaluating heath-care quality and outcomes. Because administrative databases are being used to measure the quality of heath care and judge outcomes, it is imperative that one understand the information that they contain. However, there is a paucity of published pediatric cardiac surgical mortality standards from administrative data available for comparisons. Existing published reports of pediatric cardiac surgical mortality Accepted for publication Oct 14, Presented at the Fifty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 7 10, Address correspondence to Dr Welke, Division of Cardiothoracic Surgery L353, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR ; welkek@ohsu.edu. rates from administrative data are either out of date or are based on regional populations [1, 2]. In addition, how mortality rates from administrative data compare with rates from contemporary clinical data is unknown. The purpose of this investigation is to calculate pediatric cardiac surgical mortality rates from administrative data and compare them with widely quoted standards from clinical databases. Material and Methods This study was designed as a retrospective cohort analysis. The Oregon Health and Science University Institutional Review Board approved this study. Owing to the nature of the study, patient consent was not required. We obtained data from the Nationwide Inpatient Sample (NIS) and the Kids Inpatient Database (KID) [3, 4]. Both databases were derived from the Uniform Hospital Discharge Data Set, a uniform, minimum dataset that allows investigation of cost and quality of short-term hospital services across regional and national populations. Each record represents a stay in an inpatient facility and 2009 by The Society of Thoracic Surgeons /09/$36.00 Published by Elsevier Inc doi: /j.athoracsur
2 Ann Thorac Surg WELKE ET AL 2009;87: SURGICAL MORTALITY RATES 217 contains data from the 1992 Uniform Bill hospital discharge abstract. The NIS is the largest all-payer inpatient care database in the United States [3]. The database is a stratified, cross-sectional sample that includes approximately 20% of all community (nonfederal) hospital discharges in the United States. The NIS data are available from 1988 to 2005, during which time the number of states in the NIS has grown from 8 to 37. In 2005, the database contained data on approximately 8 million hospital stays at 1,054 hospitals in 37 states. The sampling frame for the 2005 NIS is a sample of hospitals that comprises approximately 90% of all hospital discharges in the United States. To ensure the representative nature of the database, the NIS is stratified by geographical region, urban versus rural location, teaching status, hospital ownership, and hospital bed size. We have previously published a description of the characteristics of NIS hospitals that performed pediatric cardiac surgery [4]. The KID was specifically designed for research on issues related to the health of children [5]. Like the NIS, the large size and national scope of the KID make it well suited for study of national trends in health-care utilization, access, charges, quality, and outcomes. The KID is available for 1997, 2000, and The scope of the database has increased from data on patients 18 years of age and younger in 22 states in 1997 to data on patients 20 years of age and younger in 36 states in Each year the KID includes 2 million to 3 million pediatric discharges sampled from 2,500 to 3,500 American Hospital Association designated community hospitals. The sampling strategy for the KID differs from that for the NIS. To ensure an accurate representation of each hospital s pediatric case mix, the discharges are sorted by state, hospital, diagnosis-related group (DRG), and a random number within each DRG. Systematic random sampling is used to select 10% of uncomplicated in-hospital births and 80% of complicated in-hospital births and other pediatric cases from each hospital for which data are available. As with the NIS, sampling weights are provided so that the KID can be used to produce national estimates. For this study we combined data from the 1988 through 2005 NIS and used data from the 2003 KID. Congenital cardiac surgical procedures performed on patients younger than 18 years of age were identified by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis and procedure codes. For a patient to be included in this study, the procedure code had to match to a plausible diagnostic code. Operations were categorized by the Risk Adjustment for Congenital Heart Surgery (RACHS-1) method [1]. This risk stratification system groups the varied congenital cardiac surgical case mix into six categories based on similar expected short-term mortality rates and was developed to compare the mortality for groups of patients undergoing congenital cardiac surgery. The Aristotle basic complexity score can also be used for this purpose in clinical data; however, because it has not been linked to ICD-9-CM codes, it is not usable with administrative data [6]. Category 1 has the lowest risk of death and category 6 the highest. Category 1 contains atrial septal defect repair, patent ductus arteriosis closure on patients older than 30 days of age, and coarctation repair on patients older than 30 days of age. Category 2 contains operations such as ventricular septal defect repair, pulmonary valve replacement, total repair of tetralogy of Fallot, and Glenn shunt. Category 3 includes operations such as aortic valve replacement, Fontan procedure, and arterial switch. Category 4 includes complex neonatal surgery such as repair of transposition with ventricular septal defect and repair of truncus arteriosis. Category 5 includes tricuspid valve repositioning for Ebstein s anomaly at 30 days of age and combined repair of truncus arteriosis and interrupted arch. Category 6 includes Norwood procedure and Damus-Kaye-Stansel procedure. The RACHS-1 method is a widely used risk stratification methodology for congenital heart surgery [7 11]. The methodology has been validated and is included in The Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database reports [12]. Owing to the small number of patients in RACHS-1 category 5 and to allow for comparison with the STS Congenital Heart Surgery Database, risk categories 5 and 6 were collapsed into a single group. To decrease the year-to-year variability, the 18-year time span of the NIS was subdivided into 6 groupings of 3 years each. Analyses were performed using SAS version 9.1 (SAS Institute, Cary, NC). Mortality was defined as in-hospital mortality as indicated by the discharge disposition. The numerator was the number of deaths and the denominator was the number of patients. We calculated case mix and in-hospital mortality rates for each RACHS-1 category. Comparisons of case mix and mortality rates between year groupings were made using 95% confidence intervals. We then compared the NIS and KID case mix and mortality rates with published mortality rates from contemporary clinical databases. We chose the Congenital Heart Surgeons Society (CHSS) cohort reported by Welke and colleagues [10] and the STS cohort reported by Jacobs and associates [13]. The CHSS cohort contained 12,672 RACHS-1 categorized cases from 2001 to 2004 voluntarily submitted by 11 institutions with CHSS member surgeons [10]. The STS cohort contained 45,635 RACHS-1 categorized operations from 2002 to 2005 voluntarily submitted by North American Congenital Heart Surgery Centers. The number of submitting centers increased from 20 in 2002 to 52 in 2005 [13]. Results From 1988 to 2005, 124,087,005 discharges from 3,948 hospitals were recorded in the NIS. Of these discharges, 55,164 were patients who underwent a congenital cardiac procedure coded in RACHS-1. These operations occurred at 307 hospitals. During the 18-year study period, the case mix of NIS hospitals performing pediatric cardiac surgery remained similar with the notable exception of category 5 and 6 (Table 1). The percentage of category 5 and 6 cases in the
3 218 WELKE ET AL Ann Thorac Surg SURGICAL MORTALITY RATES 2009;87: Table 1. Nationwide Inpatient Sample Case Mix and Mortality Rates by Risk Adjustment for Congenital Heart Surgery, Version 1, Category ( ) a Case Mix Mortality RACHS-1 Category Number of Cases Percentage 95% CI Number of Deaths Percentage 95% CI , , , , , , , , , , , , , , , , , , , & Total , , , , , , a Case counts and deaths are raw data from the Nationwide Inpatient Sample. Percentages and confidence intervals are based on weighted values. CI confidence interval; RACHS-1 Risk Adjustment for Congenital Heart Surgery, version 1. NIS increased steadily from 0.51% to 3.32% (p 0.05). This significant increase likely reflects the acceptance of the Norwood procedure (a RACHS-1 category 6 operation) as treatment for hypoplastic left heart syndrome and other single-ventricle anomalies. During the course of the study period, the overall in-hospital mortality rate for congenital cardiac surgical procedures performed at NIS hospitals decreased from 8.7% to 4.6% (p 0.05). Mortality rates in all RACHS-1 categories declined during the study period as well
4 Ann Thorac Surg WELKE ET AL 2009;87: SURGICAL MORTALITY RATES 219 Table 2. Comparison of Administrative and Clinical Data Case Mix and Mortality Rates by Risk Adjustment for Congenital Heart Surgery, Version 1, Category a Case Mix Mortality RACHS-1 Category Number of Cases Percentage 95% CI Number of Deaths Percentage 95% CI 1 NIS STS [5] NIS CHSS [4] KID 2003 [1] NIS STS [5] NIS CHSS [4] KID 2003 [1] NIS STS [5] NIS CHSS [4] KID 2003 [1] NIS STS [5] NIS CHSS [4] KID 2003 [1] &6 NIS STS [5] NIS CHSS [4] KID 2003 [1] Total NIS STS [5] NIS CHSS [4] KID 2003 [1] Numbers in brackets are reference citations. a Case counts and deaths are raw data from the Nationwide Inpatient Sample. Percentages and confidence intervals are based on weighted values. CI confidence interval; CHSS Congenital Heart Surgeons Society; KID Kids Inpatient Database; NIS Nationwide Inpatient Sample; STS The Society of Thoracic Surgeons. (Table 1). Owing in part to the small number of cases performed in the early years, the decrease in category 5 and 6 mortality from 40.5% to 29.1% did not reach statistical significance. In the KID 2003, 1,905,797 discharges from 2,521 hospitals were recorded. Of these discharges, 10,945 were patients who underwent a congenital cardiac procedure coded in RACHS-1. These operations occurred at 151 hospitals. Thirty of these hospitals were children s general hospitals, 62 children s units in general hospitals, and 59 were not identified as children s hospitals. The mortality rates for the KID were similar to contemporary NIS data (Table 2). Although there were slight differences in case mix between the administrative and clinical databases, there was no consistent pattern of discrepancy (Table 2). The slight disparities may reflect the differences in the hospital compositions of the cohorts. The NIS includes a broad range of hospitals chosen to be representative of national practice. The STS and CHSS cohorts include groups of hospitals that are more likely to contain pediatric cardiac specialty centers.
5 220 WELKE ET AL Ann Thorac Surg SURGICAL MORTALITY RATES 2009;87: Overall mortality in the NIS administrative data was higher than mortality rates from contemporary clinical databases (Table 2). Category-specific mortality rates from the STS 2002 to 2005 and CHSS 2001 to 2004 clinical cohorts were similar to the NIS administrative data for category 1, 2, 4, and 5 and 6 cases. Mortality rates from the clinical databases were significantly lower than those from the NIS for category 3 cases. Comment In this analysis of 18 years of national administrative data, we found that pediatric cardiac surgical mortality rates have decreased substantially. However, compared with contemporary clinical databases, overall mortality rates in administrative data were higher. The discrepancy may be attributable to several factors: differences in database design and composition, differences in data collection and reporting structures, and variation in data quality. This comparison is timely as governmental agencies, insurance companies, and other stake holders attempt to define the data sources and metrics that will be used to evaluate providers in terms of cost and quality in the pay for performance movement [14]. Administrative databases were designed for the collection of data about claims and billing. Subsequently, these data were used for calculating publicly reported surgical rates of mortality and for profiling of providers. Two administrative databases have applicability to congenital cardiac surgery, the NIS and the KID. Administrative databases are relatively inexpensive and readily available, and include large groups of patients from state or national areas. In addition, they are often available for a number of years, facilitating longitudinal studies. Because of their large size, these databases can generate sample sizes often not available in single-center or even multiinstitutional databases. This large volume of data is especially helpful for the study of rare diagnoses and procedures. The large size of administrative databases also may mitigate, in part, coding inaccuracies. Because they were designed for billing purposes, administrative databases excel as sources of financial data not available from other sources [15]. Administrative databases are inclusive by design. They either include all hospitals within a specified geographic area, such as state-level databases, or use a stratified sampling design that allows a fixed percentage of hospitals to accurately represent the entire sampling universe. Findings from within the sample can, therefore, be readily generalized to the larger population from which the sample was selected. By including information from both high- and low-performing and high- and low-volume hospitals, administrative data can be used to evaluate the practice of hospitals that are less likely to participate in large, voluntary, clinical databases. The broader scope of administrative data is emphasized by the observation that, using the NIS, we identified 307 hospitals in the United States at which pediatric heart surgery was performed. This is in contrast to the 122 centers identified by the 2005 Society of Thoracic Surgeons Congenital Heart Surgery Practice and Manpower Survey [16]. This suggests that a minority of hospitals performing congenital heart surgery in the United States consider themselves specialty centers. The low surgical volumes at many centers support this assumption [4]. Inclusiveness also provides a unique opportunity to study trends and patterns among regional or national geographic areas. Despite these advantages, administrative data have important limitations [17]. Many of these are a result of the documentation of the clinical status of the patients using codes from the ICD-9-CM. Although in general these codes from the ICD-9-CM capture a great amount of detail about diagnoses and procedures, multiple areas exist in which the codes are nonexistent or lack the desired granularity [18, 19]. For example, there is no procedure code for the Norwood operation. To select Norwood operations from an administrative database, one must construct a composite coding algorithm that contains individual procedural elements encompassing the Norwood operation. In addition, diagnostic codes from the ICD-9-CM do not capture many findings from physical examination, diagnostic findings, laboratory values, and hemodynamic measurements that have prognostic value and importance in risk models. The complex case mix of pediatric cardiac surgery and the structure of the collection of administrative data lead to considerable variation in data quality [20, 21]. The administrative coding personnel who obtain the 1992 Uniform Bill data from abstraction of the chart are skilled in coding, but they are not clinicians and they have no contact with the clinical team or the patient; their abstractions are derived solely from what is explicitly stated in the medical record. Variation in the quality of administrative data may also result in part from the agenda for coding being financially driven. A greater impact likely comes from a combination of the coders limited knowledge of pediatric cardiac surgery, their restricted ability to clarify conflicts in the data and fill in missing data, and poor or inconsistent documentation in the medical record [22]. In addition, inasmuch as procedures in similar categories may be performed in both the operating room and the cardiac catheterization laboratory, miscoding of interventional procedures as surgical procedures occurs. On the other hand, coding personnel are unbiased. They have no stake in the hospital outcomes and, therefore, have no incentive to favorably report data. Clinical databases are maintained by several groups: professional organizations, such as the STS, the European Association for Cardio-Thoracic Surgery, and the Pediatric Cardiac Care Consortium; states, such as the New York Cardiac Surgery Reporting System; hospitals; and private groups [23, 24]. Many of these databases, such as the STS Congenital Heart Surgery Database, were designed for quality improvement. Clinical data are collected by clinical personnel, who have a better knowledge of cardiac surgery than do administrative coding personnel. In circumstances in which they are not intimately involved in the process of care of the patient, they can identify where preoperative patient-level comorbidi-
6 Ann Thorac Surg WELKE ET AL 2009;87: SURGICAL MORTALITY RATES 221 ties are recorded, review the operative notes for surgical data, and follow the patient daily to track complications. As a result, clinical data may be more accurate than administrative data; however, they too suffer from a limited number of elements of data, inaccuracies of coding, and the lack of long-term follow-up. The close association between those who collect the data and those invested in how the data are used has led to the presumption that physicians and other health-care providers will game the system through the data collection process. This concern has increased with the implementation of reporting of medical and surgical outcomes to the public and governmental pay-for-participation programs, along with the potential implementation of initiatives involving pay for performance, and has led some to question the validity of clinical data. Although there is no evidence that STS hospitals game the system by underreporting mortality, the STS data quoted in this study were not validated. The STS has since (2007) implemented a site visit data validation program to address this concern. Participation in most clinical databases is voluntary, resulting in important biases regarding outcomes. Hospitals with limited resources or those with lower performance may abstain from participation, thus weakening the comparative power of clinical databases and potentially inflating favorable results derived from participants. In particular, hospitals that choose to participate must have the infrastructure in place to collect data, which may differentiate them from nonparticipating hospitals. They may be more likely to also engage in other practices that lead to better outcomes. Rather than being broad cohorts of all comers like the NIS and the KID, the clinical databases used in this study were select subsets that could be expected to contain a greater proportion of institutions specializing in congenital cardiac disease. The CHSS cohort was a group of hospitals that were presumed to be committed to excellence in congenital heart disease based on surgeon membership in the Congenital Heart Surgeons Society. The STS cohort was a group that voluntarily chose to participate in the STS Congenital Heart Surgery Database. Although coding errors are widely perceived to be mainly a drawback of administrative data rather than clinical data, such a perception is oversimplified and potentially dangerous, as both are likely to contain some level of inaccuracy. The clinical data used in this study were submitted by the responsible surgeons or centers and were not validated. In a recent study, the Toronto Cardiovascular Surgery Database for Congenital Heart Surgery was deliberately seeded with three types of errors: errors of omission of data, errors of miscoding of outcomes such as alive or dead, and the miscoding of procedures [25]. Expectedly, random errors had little effect, but rates of mortality calculated from the seeded database and the pristine database were sensitive to even small levels of miscoding of procedures and outcomes. The impact of these coding errors on an analysis varies depending on the focus of the investigation. If coding errors are random within the population, their impact is diminished by the large sample sizes available with administrative and, to a certain extent, clinical data. The result of such random miscoding would be to bias the results of an analysis toward the null hypothesis. However, in a small subset of the data, potential errors may not be randomly distributed and may confound the findings. When studying operations, errors from miscoded data can be reduced by including records in which the procedural code matches to a plausible diagnostic code as was done in the present investigation. For example, a patient would have to both have the diagnosis of tetralogy of Fallot and undergo the procedure of repair of tetralogy of Fallot to be included in a cohort. Using this same strategy one can also reduce the number of patients with associated lesions, such as atrioventricular septal defect with tetralogy of Fallot, from being included in isolated lesion studies. Administrative and clinical databases each have strengths that make them suited for different, but complementary, purposes. Administrative data are widely available to payers, governmental agencies, and groups that produce Internet and other reports that reach patients, their families, and providers. Such data provide an unbiased, national picture of the practice of medicine. High- and low-performing hospitals are included, allowing one to evaluate the practice of hospitals that are less likely to participate in voluntary, clinical databases. Because they were designed for billing, administrative databases are rich in cost data, making them useful for economic analyses. Clinical databases have more detailed operative and complication data. They are the choice for investigations and risk stratifications that rely on accurate comorbidity and risk factor data, such as determining performance benchmarks. For such efforts to be most useful, the validity of both administrative and clinical data must be improved. Ideally, future work to take advantage of the strengths of both types of data and to minimize their weaknesses will lead to the best understanding of the practice and outcomes of pediatric cardiac care. References 1. Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002;123: Bazzani LG, Marcin JP. Case volume and mortality in pediatric cardiac surgery patients in California, Circulation 2007;115: HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality, Rockville, MD. Available at Accessed March 1, Welke KF, Diggs BS, Karamlou T, Ungerleider RM. The relationship between hospital surgical case volumes and mortality rates in pediatric cardiac surgery: a national sample, Ann Thorac Surg 2008;86: HCUP Kids Inpatient Database (KID). Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality, Rockville, MD. Available at www. hcup-us.ahrq.gov/kidoverview.jsp. Accessed November 5, 2007.
7 222 WELKE ET AL Ann Thorac Surg SURGICAL MORTALITY RATES 2009;87: Lacour-Gayet F, Clark D, Jacobs J, et al. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004;25: Jenkins KJ, Gauvreau K. Center-specific differences in mortality: preliminary analyses using the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method. J Thorac Cardiovasc Surg 2002;124: Boethig D, Jenkins KJ, Hecker H, Thies WR, Breymann T. The RACHS-1 risk categories reflect mortality and length of hospital stay in a large German pediatric cardiac surgery population. Eur J Cardiothorac Surg 2004;26: Kang N, Cole T, Tsang V, Elliot M, de Leval M. Risk stratification in paediatric open-heart surgery. Eur J Cardiothorac Surg 2004;26: Welke KF, Shen I, Ungerleider RM. Current assessment of mortality rates in congenital cardiac surgery. Ann Thorac Surg 2006;82: Al-Radi OO, Harrell FE Jr, Caldarone CA, et al. Case complexity scores in congenital heart surgery: a comparative validation study of the Aristotle Basic Complexity score and the Risk Adjusted Congenital Heart Surgery (RACHS-1) system. J Thorac Cardiovasc Surg 2007;133: The Society of Thoracic Surgeons Congenital Heart Surgery Database 2007 Congenital Report Executive Summary. Available at Congenital_Report_Executive_Summary_All_Patients.pdf. Accessed November 5, Jacobs JP, Jacobs ML, Lacour-Gayet FG, et al. Case-mix complexity adjustment using both RACHS-1 and Aristotle applied to operations in the STS congenital database. Pediatr Cardiol In press. 14. Rosenthal MB, Fernandopulle R, Song HR, Landon B. Paying for quality: providers incentives for quality improvement. Health Affairs 2004;23: Glance LG, Dick AW, Osler TM, Mukamel DB. Does date stamping ICD-CM codes increase the value of clinical information in administrative data? Heath Serv Res 2006;41: Jacobs ML, Mavroudis C, Jacobs JP, Tchervenkov CI, Pelletier GJ. Report of the 2005 STS congenital heart surgery practice and manpower survey: a report from the STS work force on congenital heart surgery. Ann Thorac Surg 2006;82: Shahian DM, Silverstein T, Lovett AF, Wolf RE, Normand SLT. Comparison of clinical and administrative data sources for hospital coronary artery bypass graft surgery report cards. Circulation 2007;115: Iezzoni LI. Assessing quality using administrative data. Ann Intern Med 1997;127: Mack MJ, Herbert M, Prince S, et al. Does reporting of coronary artery bypass grafting from administrative databases accurately reflect actual clinical outcomes? J Thorac Cardiovasc Surg 2005;129: Cronk CE, Malloy ME, Pelech AN, et al. Completeness of state administrative databases for surveillance of congenital heart disease. Birth Defects Res A Clin Mol Tetratol 2003;67: Frohnert BK, Lussky RC, Alms MA. Validity of hospital discharge data for identifying infants with cardiac defects. J Perinatol 2005;25: Finlayson EVA, Birkmeyer JD, Stukel TA, Siewers AE, Lucas FL, Wennberg DE. Adjusting surgical mortality rates for patient comorbidities: more harm than good? Surgery 2002; 132: Moller JH, Powell CB, Joransen JA, Borbas C. The pediatric cardiac care consortium revisited. Jt Comm J Qual Improv 1994;20: Pediatric Congenital Cardiac Surgery in New York State Albany: New York State Department of Health, Gallivan S, Stark J, Pagel C, Williams G, Williams WG. Dead reckoning: can we trust estimates of mortality rates in clinical databases? Eur J Cardiothorac Surg 2008;33: DISCUSSION DR JOHN EDMUND MAYER (Boston, MA): Thanks very much and congratulations on a nice presentation and very nice work comparing this data. I think you have correctly emphasized the importance of clinical databases versus those that are based on administrative claims data. You may or may not have seen a paper in Circulation earlier this year that compared the coronary bypass, numbers of cases, in Massachusetts compared to those derived from administrative claims data. Frighteningly, there was a 27% difference in simply the number of cases counted as isolated coronary artery bypass, which I think makes the point that the administrative claims data is at least potentially flawed. I think that the real strength is actually if one can merge the clinical data with the financial administrative claims data that is contained in the HCUP (Healthcare Cost and Utilization Project) or other databases, and I am sure you are aware that in Virginia, at least, the Virginia Cardiac Surgical Quality Initiative actually was able to do that and then was actually able to find out what the savings were if one reduced complication rates as a for instance. I think where the real power is going to come from is the actual ability to merge the clinical data, which I think we all feel is more likely to be accurate, with the financial data that comes out of the hospital data sets. So those considerations lead me to two questions, one of which you already alluded to, and one is, what were the number of cases, or give us some idea about the percentage of cases that you could not classify using RACHS to risk adjust? What percentage couldn t be captured by that system? In the early years of RACHS, there were as many as 12% to 15% of the cases that couldn t be classified. So that is question one. And then the second question is whether or not you have actually gone ahead and started to look at some of that financial data in that HCUP database and whether or not you found any relationships between clinical outcomes and cost? DR WELKE: Dr Mayer, thank you very much for your questions. I will address the Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) question first. The percentage of cases in a database that are classified by RACHS-1 depends on the scope of the database and the denominator that one chooses. There are specific cases that were excluded from RACHS-1 when it was developed because of concerns that the mortality from these cases was not directly related to the operation. Two notable operations are ligation of patent ductus arteriosis in patients under 30 days of age and heart transplantation. When choosing a denominator, one can include all cardiac cases or only cases that utilized cardiopulmonary bypass. Additionally thoracic cases can be included or excluded. Depending on how the denominator is chosen, the percentage of cases in a database that will be captured by RACHS-1 can range from 80% to 90%. The Aristotle Basic Complexity Score, which is also used in The Society of Thoracic Surgeons Congenital Heart Surgery Database, captures a higher percentage of operations but is not yet coded for use in administrative data. We are working on that. To answer your second question, there has been a lot of discussion at this meeting about the flaws of administrative data;
8 Ann Thorac Surg WELKE ET AL 2009;87: SURGICAL MORTALITY RATES 223 however, there are areas where administrative data are very rich. Since administrative databases were designed to capture billing information, they are very rich in financial data. We have not yet examined cost data; however, we plan to do so. As you suggested, combining the strengths of administrative data and clinical data will give us the best overall picture of our practice. The first step toward this end is to compare the coding of variables in the two databases. The Society of Thoracic Surgeons is working with the Agency for Healthcare Research and Quality to compare The Society of Thoracic Surgeons short lists of congenital diagnosis and procedure codes to International Classification of Diseases, 9th Clinical Modification (ICD-9-CM) codes used in administrative databases so that we can begin to scrutinize the discrepancies between clinical data and administrative data. After this work has been done, we can engage in research that takes advantage of the superior coding of clinical data in a clinical database and the billing data available in an administrative database. Thank you. DR FREDERICK GROVER (Denver, CO): Karl, this is a very important paper and well presented and analyzed, and I think John s points are very important. And I would just like to emphasize that our Washington office is constantly trying to push quite a bit against administrative data as a measure of quality or a measure of how we are working, but, exactly, trying to take advantage of its stronger points, which is the financial data, and, potentially with CMS (Centers for Medicare and Medicaid Services), late mortality data. It is a way that we can get into long-term follow-up quickly before we do our own late follow-up. But just to give you an idea, when Jeff Rich did the Virginia demonstration project, if you used administrative data to identify the best users of internal mammary artery, which is one of the measures that adult cardiac surgeons are so-called judged by, an institution would have been awarded on their administrative data by being the best when it was really the worst. There are just certain things that you can t count on in administrative data. But the problem is it is easy and it is cheap, and even though a lot of it is erroneous, it will be pushed, and this is why it is so important, and I think other specialties will figure this out when they get report cards or whatever, that if you don t have your own clinical database where you are really collecting the important things that you are liable to be judged inappropriately. You mentioned that you would like to improve the quality of the data in the administrative databases, and I guess my question is, since most of this is billing and coding data and it is motivated to bill as much as you can and get as much credit, how would you do that? How would you envision improving the quality of the administrative data collected? DR WELKE: Thank you, Dr Grover. The first step in improving the quality of administrative data is to look for coding discrepancies by cross coding the diagnoses and procedure codes for administrative data with those from clinical data as we are doing in concert with the Agency for Healthcare Research and Quality. We have to see how accurate and complete the data are before we can move forward with investigations of billing correctness and cost. It is exciting that those who have the data, the Agency for Healthcare Research and Quality, want to work with us to check the quality of their data. Of course, they are hoping the administrative data look good. We think that the clinical data are going to look good. We will probably end up somewhere in the middle, but that is the place to start. Hopefully this effort will result in changes that will improve the coding and quality of administrative data and everyone will benefit.
The Influence of Surgeon Specialty on Outcomes in General Thoracic Surgery: A National Sample 1996 to 2005
The Influence of Surgeon Specialty on Outcomes in General Thoracic Surgery: A National Sample 1996 to 2005 Paul H. Schipper, MD, Brian S. Diggs, PhD, Ross M. Ungerleider, MD, MBA, and Karl F. Welke, MD,
More informationChildren with Single Ventricle Physiology: The Possibilities
Children with Single Ventricle Physiology: The Possibilities William I. Douglas, M.D. Pediatric Cardiovascular Surgery Children s Memorial Hermann Hospital The University of Texas Health Science Center
More informationSTATISTICAL MODELING OF MORTALITY RISK FOR CONGENITAL HEART DEFECTS
STATISTICAL MODELING OF MORTALITY RISK FOR CONGENITAL HEART DEFECTS Khoa DINH Department Of Mathematics and Statistics, Minnesota State University, Mankato, Mn 56001 E-mail: khoa.dinh@mnsu.edu Vasileios
More informationMajor Infection After Pediatric Cardiac Surgery: External Validation of Risk Estimation Model
Major Infection After Pediatric Cardiac Surgery: External Validation of Risk Estimation Model Andrzej Kansy, MD, PhD, Jeffrey P. Jacobs, MD, PhD, Andrzej Pastuszko, MD, PhD, Małgorzata Mirkowicz-Małek,
More informationNIH Public Access Author Manuscript World J Pediatr Congenit Heart Surg. Author manuscript; available in PMC 2015 April 01.
NIH Public Access Author Manuscript Published in final edited form as: World J Pediatr Congenit Heart Surg. 2014 April ; 5(2): 272 282. doi:10.1177/2150135113519455. Linking the Congenital Heart Surgery
More informationTrends in 30-day mortality rate and case mix for paediatric cardiac surgery in the UK between 2000 and 2010
To cite: Brown KL, Crowe S, Franklin R, et al. Trends in 30-day mortality rate and case mix for paediatric cardiac surgery in the UK between 2000 and 2010. Open Heart 2015;2:e000157. doi:10.1136/openhrt-2014-000157
More informationRelative Impact of Surgeon and Center Volume on Early Mortality After the Norwood Operation
Relative Impact of Surgeon and Center Volume on Early Mortality After the Norwood Operation Christoph P. Hornik, MD, Xia He, MS, Jeffrey P. Jacobs, MD, Jennifer S. Li, MD, MHS, Robert D.B. Jaquiss, MD,
More informationAdults or Big Kids: What Is the Ideal Clinical Environment for Management of Grown-Up Patients With Congenital Heart Disease?
ORIGINAL ARTICLES: SURGERY: The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must have either an STS
More informationDisclosure. Public Reporting and Transparency of Outcomes Reporting in Pediatric Cardiac Surgery. Definition of Quality. Donabedian s Triad 10/1/2018
Public Reporting and Transparency of Outcomes Reporting in Pediatric Cardiac Surgery Jeffrey P. Jacobs, MD Professor of Surgery and Pediatrics, Johns Hopkins University Director, Andrews/Daicoff Cardiovascular
More informationKeeping Your Heart in Good Shape for a Lifetime
Keeping Your Heart in Good Shape for a Lifetime Adult Congenital Heart Program Adult Congenital Heart Program Today, children with congenital heart disease are not only surviving but thriving as adults.
More informationWhat Can the Database Tell Us About Reoperation?
AATS/STS Congenital Heart Disease Postgraduate Symposium May 5, 2013 What Can the Database Tell Us About Reoperation? Jeffrey P. Jacobs, M.D. All Children s Hospital Johns Hopkins Medicine The Congenital
More informationIncidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institutional database. Carlos M.
Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institutional database Carlos M. Mery, MD, MPH Assistant Professor, and Pediatrics Congenital Heart Texas
More informationMortality from congenital defects has declined in the
Sex Differences in Mortality in Children Undergoing Congenital Heart Disease Surgery A United States Population Based Study Ariane Marelli, MD; Kimberlee Gauvreau, ScD; Mike Landzberg, MD; Kathy Jenkins,
More informationEnhancing the Reliability of Physician Performance on Hospital Outcome Measures
White Paper Enhancing the Reliability of Physician Performance on Hospital Outcome Measures Robert Sutter, RN, MBA, MHA Brian Waterman, MPH October 2013 Table of Contents Introduction 1 Reliability of
More informationPEDIATRIC CARDIOVASCULAR SURGERY SERVICE. Referral Center for Pediatric Cardiovascular Surgery
PEDIATRIC CARDIOVASCULAR SURGERY SERVICE Referral Center for Pediatric Cardiovascular Surgery INTRODUCTION Each year 133 million children are born worldwide from a population of 6.6 billion people; one
More informationThe Heart Center. Quality Counts: Cardiothoracic Surgery and Interventional Cardiology
The Heart Center Quality Counts: Cardiothoracic Surgery and Interventional Cardiology The Cardiothoracic Surgery Program at Nationwide Children s Hospital is dedicated to the treatment of all patients,
More informationSurgical Treatment for Double Outlet Right Ventricle. Masakazu Nakao Consultant, Paediatric Cardiothoracic Surgery
for Double Outlet Right Ventricle Masakazu Nakao Consultant, Paediatric Cardiothoracic Surgery 1 History Intraventricular tunnel (Kawashima) First repair of Taussig-Bing anomaly (Kirklin) Taussig-Bing
More informationTitle: Tracheostomy after Surgery for Congenital Heart Disease: An Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database
Title: Tracheostomy after Surgery for Congenital Heart Disease: An Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database Running Head: Tracheostomy after Surgery for CHD Authors:
More informationValvular Operations in Patients With Congenital Heart Disease: Increasing Rates From 1988 to 2005
Valvular Operations in Patients With Congenital Heart Disease: Increasing Rates From 1988 to 2005 Raluca Ionescu-Ittu, MS, Andrew S. Mackie, MD, SM, Michal Abrahamowicz, PhD, Louise Pilote, MD, PhD, Christo
More information2016 Open Heart Surgery Survey. Part A : General Information. Part B : Survey Contact Information. 1. Identification UID: 2.
Part A : General Information 2016 Open Heart Surgery Survey 1. Identification UID: Facility Name: County: Street Address: City: Zip: Mailing Address: Mailing City: Mailing Zip: Medicare Provider Number:
More informationAccepted Manuscript. Assessing Risk Factors Following Truncus Arteriosus Repair: The Devil Is In The Detail. Bahaaldin Alsoufi, MD
Accepted Manuscript Assessing Risk Factors Following Truncus Arteriosus Repair: The Devil Is In The Detail Bahaaldin Alsoufi, MD PII: S0022-5223(19)30257-0 DOI: https://doi.org/10.1016/j.jtcvs.2019.01.047
More informationCongenital Heart Defects
Normal Heart Congenital Heart Defects 1. Patent Ductus Arteriosus The ductus arteriosus connects the main pulmonary artery to the aorta. In utero, it allows the blood leaving the right ventricle to bypass
More informationCardiac surgery relative to population: pattern of cardiac surgery in South Australia,
Thorax, 1977, 32, 57-577 Cardiac surgery relative to population: pattern of cardiac surgery in South Australia, 1949-751 H. D. SUTHERLAND, D. R. CRADDOCK, J. L. WADDY, AND G. R. NUNN From the Cardio-Thoracic
More informationRecent technical advances and increasing experience
Pediatric Open Heart Operations Without Diagnostic Cardiac Catheterization Jean-Pierre Pfammatter, MD, Pascal A. Berdat, MD, Thierry P. Carrel, MD, and Franco P. Stocker, MD Division of Pediatric Cardiology,
More informationCongenital heart disease causes an enormous health burden,
Center Variation in Hospital Costs for Patients Undergoing Congenital Heart Surgery Sara K. Pasquali, MD; Jie-Lena Sun, MS; Phil d Almada, MS; Robert D.B. Jaquiss, MD; Andrew J. Lodge, MD; Neal Miller;
More informationIndex. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A ACHD. See Adult congenital heart disease (ACHD) Adult congenital heart disease (ACHD), 503 512 across life span prevalence of, 504 506
More informationThe Society of Thoracic Surgeons General Thoracic Surgery Database: Establishing Generalizability to National Lung Cancer Resection Outcomes
The Society of Thoracic Surgeons General Thoracic Surgery Database: Establishing Generalizability to National Lung Cancer Resection Outcomes Damien J. LaPar, MD, MS, Castigliano M. Bhamidipati, DO, MS,
More informationSurgical management of congenital heart disease: evaluation according to the Aristotle score
European Journal of Cardio-thoracic Surgery 37 (2010) 210 217 www.elsevier.com/locate/ejcts Surgical management of congenital heart disease: evaluation according to the Aristotle score Jutta Heinrichs
More information5/22/2013. Alan Zuckerman 1, Swapna Abhyankar 1, Tiffany Colarusso 2, Richard Olney 2, Kristin Burns 3, Marci Sontag 4
Alan Zuckerman 1, Swapna Abhyankar 1, Tiffany Colarusso 2, Richard Olney 2, Kristin Burns 3, Marci Sontag 4 1 National Library of Medicine, NIH, Bethesda, MD, USA, 2 Centers for Disease Control and Prevention,
More informationSURGICAL VOLUME AND CENTER EFFECTS ON EARLY MORTALITY AFTER PEDIATRIC CARDIAC SURGERY: 25-YEAR EXPERIENCE FROM THE PEDIATRIC CARDIAC CARE CONSORTIUM
SURGICAL VOLUME AND CENTER EFFECTS ON EARLY MORTALITY AFTER PEDIATRIC CARDIAC SURGERY: 25-YEAR EXPERIENCE FROM THE PEDIATRIC CARDIAC CARE CONSORTIUM A THESIS SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL
More informationEndovascular technology, hospital volume, and mortality with abdominal aortic aneurysm surgery
Endovascular technology, hospital volume, and mortality with abdominal aortic aneurysm surgery Justin B. Dimick, MD, MPH, and Gilbert R. Upchurch Jr, MD, Ann Arbor, Mich Objective: To determine whether
More informationIntroduction. Study Design. Background. Operative Procedure-I
Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt Ann Thorac Surg 2009;87:178 86 86 Addressor: R1 胡祐寧 2009/3/4 AM7:30 SICU 討論室 Introduction Hypoplastic
More informationImpact of Single-Ventricle Physiology on Death After Heart Transplantation in Adults With Congenital Heart Disease
Impact of Single-Ventricle Physiology on Death After Heart Transplantation in Adults With Congenital Heart Disease Tara Karamlou, MD, MS, Brian S. Diggs, PhD, Karl Welke, MD, MS, Fred Tibayan, MD, Jill
More informationTechnical Performance Scores in Congenital Cardiac Operations: A Quality Assessment Initiative
Technical Performance Scores in Congenital Cardiac Operations: A Quality Assessment Initiative John M. Karamichalis, MD, Steven D. Colan, MD, Meena Nathan, MD, Frank A. Pigula, MD, Christopher Baird, MD,
More informationSEX, BIRTH ORDER, AND MATERNAL AGE CHARACTERISTICS OF INFANTS WITH CONGENITAL HEART DEFECTS
AMERICAN JOURNAL OF EPIDEMIOLOGY Copyright 1 by The Johns Hopkins University School of Hygiene and Public Health Vol., Xo. Printed in U.S.A. SEX, BIRTH ORDER, AND MATERNAL AGE CHARACTERISTICS OF INFANTS
More informationIntraoperative Oncologic Staging and Outcomes for Lung Cancer Resection Vary by Surgeon Specialty
Intraoperative Oncologic Staging and Outcomes for Lung Cancer Resection Vary by Surgeon Specialty Michelle C. Ellis, MD, Brian S. Diggs, PhD, John T. Vetto, MD, and Paul H. Schipper, MD Department of Surgery,
More informationValidation of Relative Value Scale for Congenital Heart Operations
Validation of Relative Value Scale for Congenital Heart Operations Kathy J. Jenkins, MD, Kimberlee Gauvreau, ScD, Jane W. Newburger, MD, Ludmila B. Kyn, MA, Lisa I. Iezzoni, MD, and John E. Mayer, MD Departments
More informationA Unique Milieu for Perioperative Care of Adult Congenital Heart Disease Patients at a Single Institution
Original Article A Unique Milieu for Perioperative Care of Adult Congenital Heart Disease Patients at a Single Institution Ghassan Baslaim, MD, and Jill Bashore, RN Purpose: Adult patients with congenital
More informationThe current trends of mortality following congenital heart surgery: the Japan Congenital Cardiovascular Surgery Database
Interactive CardioVascular and Thoracic Surgery 21 (2015) 151 156 doi:10.1093/icvts/ivv109 Advance Access publication 29 April 2015 ORIGINAL ARTICLE CONGENITAL Cite this article as: Hoashi T, Miyata H,
More informationON 6 OCTOBER, 2000, A MEETING OF
1205-04.qxd 09/Sep/02 1:13 PM Page 431 Cardiol Young 2002; 12: 431 435 Greenwich Medical Media Ltd. ISSN 1047-9511 The International Nomenclature Project for Congenital Heart Disease Bidirectional crossmap
More informationTetralogy of Fallot (TOF) with absent pulmonary valve
Repair of Tetralogy of Fallot with Absent Pulmonary Valve Syndrome Karl F. Welke, MD, and Ross M. Ungerleider, MD, MBA Tetralogy of Fallot (TOF) with absent pulmonary valve syndrome (APVS) occurs in 5%
More informationInterest in minimally invasive surgical interventions, Impact of Hospital Volume of Thoracoscopic Lobectomy on Primary Lung Cancer Outcomes
SURGERY: The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must have either an STS member or an individual
More informationCongenital Heart Surgeons Society Data Center
Congenital Heart Surgeons Society Data Center October 20-21, 2013 October 21, 2013 The Congenital Heart Surgeons Society Data Center would like to acknowledge the CONGENITAL HEART SURGEONS SOCIETY 555
More informationBridging The Cardiology Gap: Care Priorities for Adults With Congenital Heart Disease
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/medical-breakthroughs-from-penn-medicine/bridging-cardiology-gapcare-priorities-adults-congenital-heart-disease/8031/
More informationSeptember 26, 2012 Philip Stockwell, MD Lifespan CVI Assistant Professor of Medicine (Clinical)
September 26, 2012 Philip Stockwell, MD Lifespan CVI Assistant Professor of Medicine (Clinical) Advances in cardiac surgery have created a new population of adult patients with repaired congenital heart
More informationChapter 2: Identification and Care of Patients with CKD
Chapter 2: Identification and Care of Patients with CKD Over half of patients in the Medicare 5% sample (aged 65 and older) had at least one of three diagnosed chronic conditions chronic kidney disease
More informationAbsent Pulmonary Valve Syndrome
Absent Pulmonary Valve Syndrome Fact sheet on Absent Pulmonary Valve Syndrome In this condition, which has some similarities to Fallot's Tetralogy, there is a VSD with narrowing at the pulmonary valve.
More informationManagement of complex CHD in adults
Management of complex CHD in adults Victor Tsang Society of Thoracic Surgeons of Thailand 2016 The impact of infant cardiac surgery Over 90 % of infants born with CHD will reach adulthood By 2010, adults
More informationAdvanced Congenital Cardiac Morphology
Advanced Congenital Cardiac Morphology October 30 to November 3, 2016 Ruth and Tristram Colket, Jr. Translational Research Building at The Children s Hospital of Philadelphia Philadelphia, Pa. www.chop.edu/cme
More informationCurrent Status of the European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons Congenital Heart Surgery Database
Current Status of the European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons Congenital Heart Surgery Database Jeffrey P. Jacobs, MD, Marshall L. Jacobs, MD, Bohdan Maruszewski,
More informationS. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences
S. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences No financial disclosures Aorta Congenital aortic stenosis/insufficiency
More informationAccepted Manuscript. The Left atrioventricular valve: The Achilles Heel of incomplete endocardial cushion defects. Meena Nathan, MD, MPH
Accepted Manuscript The Left atrioventricular valve: The Achilles Heel of incomplete endocardial cushion defects Meena Nathan, MD, MPH PII: S0022-5223(18)32898-8 DOI: https://doi.org/10.1016/j.jtcvs.2018.10.120
More informationAdvanced Congenital Cardiac Morphology. Sunday, Oct. 22, to Thursday, Oct. 26, Learn more: chop.cloud-cme.com
Advanced Congenital Cardiac Morphology Sunday, Oct. 22, to Thursday, Oct. 26, 2017 Ruth and Tristram Colket, Jr. Translational Research Building Learn more: chop.cloud-cme.com 1 Course Information Course
More informationChapter 2: Identification and Care of Patients With CKD
Chapter 2: Identification and Care of Patients With CKD Over half of patients in the Medicare 5% sample (aged 65 and older) had at least one of three diagnosed chronic conditions chronic kidney disease
More informationOutcomes after operative correction of congenital cardiac
Repair of Simple Total Anomalous Pulmonary Venous Connection: A Review From the Pediatric Cardiac Care Consortium James D. St. Louis, MD, Brian A. Harvey, BA, Jeremiah S. Menk, MS, Geetha Raghuveer, MD,
More informationTENNCARE Bundled Payment Initiative: Description of Bundle Risk Adjustment for Wave 4 Episodes
TENNCARE Bundled Payment Initiative: Description of Bundle Risk Adjustment for Wave 4 Episodes Attention deficit hyperactivity disorder (ADHD); Opposition defiance disorder (ODD); Coronary artery bypass
More informationSubmitted to: Re: Comments on CMS Proposals for Patient Condition Groups and Care Episode Groups
April 24, 2017 The Honorable Seema Verma Administrator Centers for Medicare & Medicaid Services Hubert H. Humphrey Building 200 Independence Avenue SW Washington, D.C. 20201 Submitted to: macra-episode-based-cost-measures-info@acumenllc.com
More informationSupplementary Online Content
Supplementary Online Content Toyoda N, Chikwe J, Itagaki S, Gelijns AC, Adams DH, Egorova N. Trends in infective endocarditis in California and New York State, 1998-2013. JAMA. doi:10.1001/jama.2017.4287
More informationNATIONAL QUALITY FORUM National Voluntary Consensus Standards for Pediatric Cardiac Surgery Measures
NATIONAL QUALITY FORUM National Voluntary Consensus Standards for Pediatric Cardiac Surgery Measures Measure Number: PCS 021 09 Measure Title: Standardized Mortality Ratio for Congenital Heart Surgery,
More informationEchocardiography of Congenital Heart Disease
Echocardiography of Congenital Heart Disease Sunday, April 15 Tuesday, April 17, 2018 Ruth and Tristram Colket, Jr. Translational Research Building on the Raymond G. Perelman Campus Learn more: chop.cloud-cme.com
More informationThe Aristotle Comprehensive Complexity Score Predicts Mortality and Morbidity After Congenital Heart Surgery
ORIGINAL ARTICLES: SURGERY: The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must have either an STS
More informationDIAGNOSIS, MANAGEMENT AND OUTCOME OF HEART DISEASE IN SUDANESE PATIENTS
434 E AST AFRICAN MEDICAL JOURNAL September 2007 East African Medical Journal Vol. 84 No. 9 September 2007 DIAGNOSIS, MANAGEMENT AND OUTCOME OF CONGENITAL HEART DISEASE IN SUDANESE PATIENTS K.M.A. Sulafa,
More informationAdvanced Congenital Cardiac Morphology
Advanced Congenital Cardiac Morphology October 18 22, 2015 Ruth and Tristram Colket, Jr. Translational Research Building at The Children s Hospital of Philadelphia Philadelphia, Pa. www.chop.edu/cme Program:
More informationAlthough most patients with Ebstein s anomaly live
Management of Neonatal Ebstein s Anomaly Christopher J. Knott-Craig, MD, FACS Although most patients with Ebstein s anomaly live through infancy, those who present clinically as neonates are a distinct
More informationThe effect of surgeon volume on procedure selection in non-small cell lung cancer surgeries. Dr. Christian Finley MD MPH FRCSC McMaster University
The effect of surgeon volume on procedure selection in non-small cell lung cancer surgeries Dr. Christian Finley MD MPH FRCSC McMaster University Disclosures I have no conflict of interest disclosures
More informationEpidemiology of Aortic Aneurysm Repair in the United States from 1993 to 2003
Epidemiology of Aortic Aneurysm Repair in the United States from 1993 to 2003 JOHN A. COWAN, JR., JUSTIN B. DIMICK, PETER K. HENKE, JOHN RECTENWALD, JAMES C. STANLEY, AND GILBERT R. UPCHURCH, Jr. University
More informationSURGICAL TREATMENT AND OUTCOME OF CONGENITAL HEART DISEASE
SURGICAL TREATMENT AND OUTCOME OF CONGENITAL HEART DISEASE Mr. W. Brawn Birmingham Children s Hospital. Aims of surgery The aim of surgery in congenital heart disease is to correct or palliate the heart
More informationCost-Motivated Treatment Changes in Commercial Claims:
Cost-Motivated Treatment Changes in Commercial Claims: Implications for Non- Medical Switching August 2017 THE MORAN COMPANY 1 Cost-Motivated Treatment Changes in Commercial Claims: Implications for Non-Medical
More informationExploring the Relationship Between Substance Abuse and Dependence Disorders and Discharge Status: Results and Implications
MWSUG 2017 - Paper DG02 Exploring the Relationship Between Substance Abuse and Dependence Disorders and Discharge Status: Results and Implications ABSTRACT Deanna Naomi Schreiber-Gregory, Henry M Jackson
More information3/14/2011 MANAGEMENT OF NEWBORNS CARDIAC INTENSIVE CARE CONFERENCE FOR HEALTH PROFESSIONALS IRVINE, CA. MARCH 7, 2011 WITH HEART DEFECTS
CONFERENCE FOR HEALTH PROFESSIONALS IRVINE, CA. MARCH 7, 2011 MANAGEMENT OF NEWBORNS WITH HEART DEFECTS A NTHONY C. CHANG, MD, MBA, MPH M E D I C AL D I RE C T OR, HEART I N S T I T U T E C H I LDRE N
More informationDown Syndrome Medical Interest Group Friday, 12 June Cardiac Surgery in patients with Down Syndrome
Down Syndrome Medical Interest Group Friday, 12 June 2015 Cardiac Surgery in patients with Down Syndrome Mr. Attilio Lotto, FRCS CTh Congenital Cardiac Surgeon Cardiac surgery in patients with Down syndrome
More informationPatient is unable to communicate and caregiver/informant is unavailable to provide information. Risk
Falls Outcome for Patients with Parkinson s Disease Measure Description Percentage of patients with PD who experienced a fall in the preceding six months. Note: A lower score is desirable. Measure Components
More informationAccuracy of the Fetal Echocardiogram in Double-outlet Right Ventricle
Blackwell Publishing IncMalden, USACHDCongenital Heart Disease 2006 The Authors; Journal compilation 2006 Blackwell Publishing, Inc.? 200723237Original ArticleFetal Echocardiogram in Double-outlet Right
More informationMEDICAL SCIENCES Vol.I -Adult Congenital Heart Disease: A Challenging Population - Khalid Aly Sorour
ADULT CONGENITAL HEART DISEASE: A CHALLENGING POPULATION Khalid Aly Sorour Cairo University, Kasr elaini Hospital, Egypt Keywords: Congenital heart disease, adult survival, specialized care centers. Contents
More informationAdvanced Congenital Cardiac Morphology
Advanced Congenital Cardiac Morphology October 19 23, 2014 Ruth and Tristram Colket, Jr. Translational Research Building at Philadelphia, Pa. www.chop.edu/cme Program: Oct. 19 23, 2014 Sunday, Oct. 19
More informationDoes Volume in a Pediatric Cardiac Surgery Program Impact the Results?
Does Volume in a Pediatric Cardiac Surgery Program Impact the Results? Jeffrey P. Jacobs, MD Professor of Surgery and Pediatrics, Johns Hopkins University Director, Andrews/Daicoff Cardiovascular Program
More information2015 Facility and Physician Billing Guide Heart Valve Technologies
2015 Facility and Physician Billing Guide Heart Valve Technologies PHYSICIAN BILLING CODES Clinicians use Current Procedural Terminology (CPT 1 ) codes to bill for procedures and services. Each CPT code
More informationThe International Working Group for Mapping and Coding of Nomenclatures for Paediatric and Congenital Heart Disease
1402-23.qxd 5/7/04 4:16 PM Page 225 Cardiol Young 2004; 14: 225 229 Greenwich Medical Media Ltd. ISSN 1047-9511 The International Working Group for Mapping and Coding of Nomenclatures for Paediatric and
More informationAdult Congenital Heart Disease: What All Echocardiographers Should Know Sharon L. Roble, MD, FACC Echo Hawaii 2016
1 Adult Congenital Heart Disease: What All Echocardiographers Should Know Sharon L. Roble, MD, FACC Echo Hawaii 2016 DISCLOSURES I have no disclosures relevant to today s talk 2 Why should all echocardiographers
More informationSurgical Treatment for Atrioventricular Septal Defect. Masakazu Nakao Consultant, Paediatric Cardiothoracic Surgery
Surgical Treatment for Atrioventricular Septal Defect Masakazu Nakao Consultant, Paediatric Cardiothoracic Surgery 1 History Rastelli classification (Rastelli) Pulmonary artery banding (Muller & Dammann)
More informationAppendix A.1: Tier 1 Surgical Procedure Terms and Definitions
Appendix A.1: Tier 1 Surgical Procedure Terms and Definitions Tier 1 surgeries AV Canal Atrioventricular Septal Repair, Complete Repair of complete AV canal (AVSD) using one- or two-patch or other technique,
More informationDeok Young Choi, Gil Hospital, Gachon University NEONATES WITH EBSTEIN S ANOMALY: PROBLEMS AND SOLUTION
Deok Young Choi, Gil Hospital, Gachon University NEONATES WITH EBSTEIN S ANOMALY: PROBLEMS AND SOLUTION Carpentier classification Chauvaud S, Carpentier A. Multimedia Manual of Cardiothoracic Surgery 2007
More informationVocabulary. Bias. Blinding. Block. Cluster sample
Bias Blinding Block Census Cluster sample Confounding Control group Convenience sample Designs Experiment Experimental units Factor Level Any systematic failure of a sampling method to represent its population
More informationClinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!!
Clinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!! Abha'Khandelwal,'MD,'MS' 'Stanford'University'School'of'Medicine'
More informationCardiology Competency Based Goals and Objectives
Cardiology Competency Based Goals and Objectives COMPETENCY 1. Patient Care. Provide family centered patient care that is developmentally and age appropriate, compassionate, and effective for the treatment
More informationThe Fetal Cardiology Program
The Fetal Cardiology Program at Texas Children s Fetal Center About the program Since the 1980s, Texas Children s Fetal Cardiology Program has provided comprehensive fetal cardiac care to expecting families
More informationTransient malformations like PDA and PDA of prematurity were not considered. We have divided cardiac malformations in 2 groups:
CARDIAC MALFORMATIONS DETECTED AT BIRTH Anwar Dudin-MD, Annie Rambaud-Cousson-MD, Mahmoud Nashashibi-MD Pediatric Department Makassed Hospital Jerusalem Diagnosis of congenital heart disease in the neonatal
More informationThe incidence and risk factors of arrhythmias in the early period after cardiac surgery in pediatric patients
The Turkish Journal of Pediatrics 2008; 50: 549-553 Original The incidence and risk factors of arrhythmias in the early period after cardiac surgery in pediatric patients Selman Vefa Yıldırım 1, Kürşad
More informationORIGINAL ARTICLE. Accelerated Growth of Bariatric Surgery With the Introduction of Minimally Invasive Surgery
ORIGINAL ARTICLE Accelerated Growth of Bariatric Surgery With the Introduction of Minimally Invasive Surgery Ninh T. Nguyen, MD; Jeffrey Root, MD; Kambiz Zainabadi, MD; Allen Sabio, BS; Sara Chalifoux,
More informationMid-term Result of One and One Half Ventricular Repair in a Patient with Pulmonary Atresia and Intact Ventricular Septum
Mid-term Result of One and One Half Ventricular Repair in a Patient with Pulmonary Atresia and Intact Ventricular Septum Kagami MIYAJI, MD, Akira FURUSE, MD, Toshiya OHTSUKA, MD, and Motoaki KAWAUCHI,
More informationCoarctation of the aorta
T H E P E D I A T R I C C A R D I A C S U R G E R Y I N Q U E S T R E P O R T Coarctation of the aorta In the normal heart, blood flows to the body through the aorta, which connects to the left ventricle
More informationGENERAL COMMENTS. The Task Force Process Should be Fully Open, Balanced and Transparent
December 9, 2013 Submitted Electronically United States Preventive Services Task Force c/o Dr. Robert Cosby Agency for Healthcare Research and Quality 540 Gaither Road Rockville, MD 20850 RE: USPSTF Draft
More informationSurgical Management Of Congenital Heart Disease II: Single Ventricle And Hypoplastic Left Heart Syndrome Aortic Arch Anomalies Septal Defects And...
Surgical Management Of Congenital Heart Disease II: Single Ventricle And Hypoplastic Left Heart Syndrome Aortic Arch Anomalies Septal Defects And... Of Thoracic Arteries And Veins A Video Manual By Viktor
More informationLate Results after Correction of Ventricular Septal Defect with Severe Pulmonary Hypertension
Tohoku J. Exp. Med., 1994, 174, 41-48 Late Results after Correction of Ventricular Septal Defect with Severe Pulmonary Hypertension KIYOSHI HANEDA, NAOSHI SATO, TAKAO TOGO, MAKOTO MIURA, MASAKI RATA and
More informationHeart & Vascular Institute Outcomes
Heart & Vascular Institute & 2013 Outcomes Measuring Outcomes Promotes Quality Improvement Measuring and understanding outcomes of medical treatments promotes quality improvement. Cleveland Clinic has
More informationPattern of Congenital Heart Disease A Hospital-Based Study *Sadiq Mohammed Al-Hamash MBChB, FICMS
Pattern of Congenital Heart Disease A Hospital-Based Study *Sadiq Mohammed Al-Hamash MBChB, FICMS ABSTRACT Background: The congenital heart disease occurs in 0,8% of live births and they have a wide spectrum
More informationEchocardiography of Congenital Heart Disease
Echocardiography of Congenital Heart Disease Sunday, April 15 Tuesday, April 17, 2018 Ruth and Tristram Colket, Jr. Translational Research Building on the Raymond G. Perelman Campus Learn more: chop.cloud-cme.com
More information