Title: Quality Initiatives at STS
1Quality Initiatives at STS
- Cynthia M. Shewan, PhD
- Director, Quality, Research and Patient Safety
- The Society of Thoracic Surgeons
- NSQIP Conference
- June 26, 2007
2Quality Initiatives at STS
- Many quality initiatives stem from STSs National
Database - 3 Components
- Adult Cardiac Surgery
- General Thoracic Surgery
- Congenital Heart Surgery
3Adult 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
4General 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
5Congenital 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
6Basis for Measuring Quality
- 21 NQF-endorsed adult cardiac measures
- Structural
- Volume
- Process
- Use of Internal Mammary Artery (IMA)
- Outcomes
- Risk-adjusted Operative Mortality
7Basis for Measuring Quality
- 6 provisional general thoracic measures
- Approved by AQA
- 26 congenital heart surgery measures
- Submitted to NQF for endorsement
8Adult Cardiac Quality Initiatives
- STS Database collects data on 17 of the NQF
measures - Focus on process and outcomes measures
9NQF Measures
10Composite 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
11Composite 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
12Composite Quality Score
13Composite 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
14Composite 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.
15Quality 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
16Quality with 3rd Parties
- 3 Tier Approach to Quality
- Aggregate Level Reports
- STS Overall
- State/Regional
- Individual Participant/hospital Level Reports
- 3 Star Rating System
17Reporting Performance
- Type of Reporting Program
- Voluntary
- Mandated
- Level of Reporting
- Surgeon Group/Hospital
- Individual Surgeon
- Recipient of Report
- Private Sector
- Government
18Reporting Performance
- Type of Data
- Clinical
- Administrative
- Use of Reported Data
- Recognition
- Financial Reward/Pay for Performance
19Pay 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
20Pay 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
21New 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
22New 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
23New 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
24New 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)
25New Quality Initiatives
- 5. Addition of Participants from Another
Specialty - Congenital Cardiac Anesthesia Society (CCAS)
- Pediatric anesthesiologists
26Quality Improvement Activity
- Randomized Clinical Trial
- Secondary Prevention and CABG A Society-Led
RCT - T. Bruce Ferguson, Jr., MD, PI
- Determined that feedback improved performance
27Quality Improvement Activity
- Regional Groups
- Michigan Quality Improvement Project funded by
Blue Cross Blue Shield (BCBS) - Virginia Cardiac Surgery Quality Initiative
(VCSQI) - 12 Regional Groups
28Shaping 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)
29Shaping Future of Quality
- PCPI (Physician Consortium for Quality
Improvement) - STS surgeons serving on 3rd party quality boards
- United HealthCare
- Blue Cross Blue Shield Association
30Shaping Future of Quality
- Strong Advocacy Presence in Washington, DC
- Need to use clinical data
- Focus on participation, improvement, performance
- Testify before Congress
31Quality Initiatives at STS