STS National Database

Transcription

1 STS National Database The U.S. Agency for Healthcare Research and Quality (AHRQ) Learning Network for Chartered Value Exchanges (CVEs) Webinar: Using Registries for Health Care Quality Measurement Thursday, April 3, :30a.m. 1:00p.m. ET Presenter Jeffrey P. Jacobs, M.D., FACS, FACC, FCCP Professor of Cardiac Surgery (PAR), Johns Hopkins University Director, Andrews/Daicoff Cardiovascular Program Surgical Director of Heart Transplantation and Extracorporeal Life Support Programs, Johns Hopkins All Children s Heart Institute 1 Disclosure 1. Chair of the STS Database Access and Publications Task Force 2. Chair of the STS Database Task Force on Longitudinal Follow up and Linked Registries 3. Chair of the STS Database Public Reporting Task Force 2 1

2 Overview of Today s Presentation 1. Introduction to STS National Database 2. Public Reporting with the STS National Database 3. Chartered Value Exchanges (CVEs), Quality Improvement, and the STS National Database 3 History of the STS National Database The STS National Database was established in 1989 as an initiative for quality improvement and patient safety among cardiothoracic surgeons. Three components to the database: STS Adult Cardiac Surgery Database established 1989 o Atrial Fibrillation Module o Anesthesia Module STS General Thoracic Surgery Database established 1994 STS Congenital Heart Surgery Database established 2002 o Anesthesia Module 4 2

3 Database Participants By the Numbers* Adult Cardiac Surgery Database 1068 US & Canada Sites > 90% of hospitals and adult cardiac operations in USA 5 International Sites (Turkey, Israel, Jordan and Brazil) 13 sites participate in the A fib module 13 sites participate in the Adult Cardiac Anesthesia Module General Thoracic Surgery Database 240 US & Canada Sites Congenital Heart Surgery Database 113 US & Canada Sites 93.6% of hospitals in USA and >95% pediatric cardiac operations in USA 1 International Site (Turkey) 42 sites participate in the Congenital Anesthesia Module *As of 3/19/14 5 [ Accessed January 22,

4 [ Accessed January 22, [ Accessed January 22,

5 Domains of STS Database Outcomes Analysis Quality Improvement Patient Safety 9 Goals of STS Database Assess Health Care: 1. Structure 2. Process 3. Outcome 10 5

6 Roles of STS Database Quality Improvement Comparative Effectiveness Research Device Surveillance Measure risk adjusted mortality and morbidity Measure processes of care Measure functional health status of patients Measure re interventions Measure quality of life Measure patient satisfaction Measure cost of health care Public Reporting of Outcomes 11 Overview of Public Reporting Rationale for Public Reporting Explanation of Composite Scores and Star Ratings Isolated CABG Isolated AVR AVR+CABG STS Public Reporting Online Collaboration with Consumer Reports 12 6

7 Rationale for Public Reporting It is our professional responsibility Our patients and their families have the right to know the outcomes of cardiothoracic surgery STS and its members are committed to transparency and accurate reporting of CT surgery outcomes Public Reporting is the next responsible step in continuing our dedication to professional accountability STS continues to lead efforts in the reporting of clinical outcomes data to the public If we do not publish our own results, the public will judge our performance based on unadjusted or inadequately adjusted administrative data Source: 13 STS Public Reporting Initiatives The STS portfolio of composite measures continues to grow 1 ST TIME PUBLICLY REPORTED CABG Composite September 2010 AVR Composite January 2013 AVR+CABG Composite Aug/Sep

8 STS CABG Composite Score To assess overall quality, 11 NQF endorsed measures were grouped into the following 4 domains: 1. Absence of operative mortality; 2. Absence of major morbidity; 3. High quality intraoperative care as measured by the use of an internal mammary artery; and 4. Appropriate perioperative medication usage 15 STS CABG Composite Score 99% Bayesian probability that provider differs from STS average 16 8

9 STS CABG Composite Score 17 STS CABG Composite Score Star Ratings Over Time Spring 2010 Fall 2010 Spring 2011 Fall 2011 Spring 2012 Fall 2012 Spring 2013 Fall % 10.5% 11% 10.9% 9.6% 9% 9% 9.7% Star Rating % 76.1% 75.5% 74.8% 76.5% 77% 76% 76.9% % 13.4% 13.5% 14.4% 14% 14% 15% 13.4% 18 9

10 The New England Journal of Medicine 19 STS AVR Composite Score Composite measure with 2 domains: 1. Absence of operative mortality 2. Absence of major morbidity No process measures For AVR there are currently no widely accepted process measures as there are for CABG (i.e. medication measures and IMA use) Note: Transcatheter Aortic Valve procedures are not included in the AVR Composite Score 20 10

11 STS AVR Composite Score No good analogue for IMA use and meds Fewer cases (3 years of data) 97.5% Bayesian probability that provider differs from STS average 21 STS AVR Composite Score Fall 2012 Spring 2013 Fall % 3% 2.7% Star Rating 2 91% 91% 91.4% 3 6% 6% 5.9% 22 11

12 NEW STS AVR + CABG Composite Score Same 2 domains as AVR Composite Score 97.5% Bayesian probability that provider differs from STS average 23 STS AVR + CABG Composite Score Fall % Star Rating % 3 6.4% 24 12

13 Public Reporting Initiatives 1. STS Public Reporting Online 2. STS collaboration with Consumer Reports Both initiatives will include: Participant group and hospital level reporting Scores and ratings for all 3 composite measures (CABG, AVR, and AVR+CABG) and their respective domains 25 STS Public Reporting Online 26 13

14 Consumer Reports 27 Consumer Reports 28 14

15 Consumer Reports 29 In The Future Continued growth in adult cardiac surgery Mitral valve repair composite to be developed Public reporting in other areas Congenital in late 2014 (tentative) General thoracic in

16 Contacts How CVEs could encourage participation in Public Reporting STS Public Reporting Online: Jane Han Senior Manager, Quality Metrics & Initiatives (312) Jeff Jacobs (727) Consumer Reports (CR): Doris Peter, PhD Associate Director, CR Health Ratings Center 31 Courtesy of Robert Beekman, MD Traditional Quality Assurance : A focus on the tail QA threshold (standard) better B Quality A worse `acceptable' quality `unacceptable' quality 32 16

17 Courtesy of Robert Beekman, MD Focus on the Tail to Assure Quality... assumes that, if serious failures (the tail) are eliminated, what remains is somehow excellent. Eliminating the lower 5% does little to affect overall system quality 33 Courtesy of Robert Beekman, MD To Truly Improve Quality the System Must 1) Eliminate unnecessary variation* (e.g. standardize processes) 2) Achieve & document continuous improvement (in care processes & outcomes) * Reinertsen JL. Zen and the Art of Physician Autonomy Maintenance. Ann Intern Med. (2003);138:

18 Courtesy of Robert Beekman, MD True Quality Improvement Moves the Mean AND Reduces Unnecessary Variation 35 A rising tide lifts all boats

19 Healthcare QI is essential if we are to bring medical breakthroughs to patients reliably & effectively Improving Patient Health Health care QI Outcomes Research Clinical Trials Translational Research Basic research Courtesy of Robert Beekman, MD and John Bucuvalas, MD 37 Summary 1. STS National Database is the largest cardiac surgical database in the world 2. All cardiac surgery programs in the USA should participate in the STS National Database and Publicly Report their outcomes 38 19

20 Science tells us what we can do; Guidelines what we should do; & Registries what we are actually doing