Download - Public reporting Of Cardiac Data
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PUBLIC REPORTING OF CARDIAC DATA
ACHA Policy Advisory Council
March 15, 2013
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Public Reporting
Jeffrey Bott, MD, MBAPresident of the Florida Society of
Cardiovascular and Thoracic SurgeonsOrlando Regional Medical Center
○ Chairman of Department of Thoracic SurgerySoon to transition from private practice to
hospital employed250 to 300 “open heart” cases/yearDatabase participantPublicly report
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Public Reporting Society of Thoracic Surgeons (STS)
Founded in 19646600 members
○ 1/2 to 2/3 are active (>20 hrs./wk.) adult cardiac surgeons
○ 90% report data to the STS42% agree to Public Reporting
- Consumer Union- STS website
“STS believes the public has a right to know the quality of surgical outcomes and considers public reporting an ethical responsibility of the specialty.”
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Public Reporting
DatabaseStarted in 1989Housed at Duke Clinical Research InstituteOver 4.5 million patients in the database
○ No other database like it in the worldClinical data, not claims 9 page form and 100’s of fields on every
patientUniform definitions ensure accuracy and
purity
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Public Reporting
DatabaseAll participants pay to submit dataRisk adjustedPeer reviewed and auditedCurrently 1071 “practices” reporting
○ 250 publicly reportFeedback provided quarterly for all
participants
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Public Reporting
MethodsOnline at STS.orgConsumer Reports
○ NQF approved metrics4 Domains + composite
- Preoperative- Intraoperative- Post operative complications- Mortality
○ Star ratings (1 – 3)
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Public Reporting
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Public Reporting
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Public Reporting
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Public Reporting
Pro’sProfessional and ethical responsibilityRobust database without equal
○ Far superior to any administrative claims data○ Clinically useful○ Risk adjusted
Can draw reliable meaningful conclusionsProvides methods for analysis of CQI and
Patient Safety initiatives
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Public Reporting
Pro’sConsumer choice
○ Transparency○ Accountability
Affirms fundamental ethical right of patient autonomy
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Public Reporting Con’s
Cost○ Money○ Time
Requires expertise○ Statistics○ Medical knowledge
Errors○ Few MD’s have the time to audit and correct
Most have non-clinical abstractors submittingNow too large for DCRI to do anything but random audits
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Public Reporting
Con’sSkewed
○ Good penetrance – over 90%○ Only 42% Publicly report
Hospital level reporting○ Not reflective of an individual surgeon
One exception
○ Multiple MD’s at multiple hospitalsSmall denominators (sample size)
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Public Reporting
Con’sMarketing
○ Costs to systemRefusal to care for sicker patients
○ New York#1 problem……..
○ Nothing to compare surgical outcomes againstNo data on the medical treatment of patientsNo data on the percutaneous treatment of patientsNeed longitudinal studies
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Public Reporting
SummaryData allows one to draw meaningful
conclusions but is quite complexAffirms patient right to know but will that
translate into action (example)Data is robust/reliable but nothing
longitudinal for comparison May result in denial of careNo mechanism to help those on the left side
of the bell curve
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Public Reporting
SuggestionsEnforce reporting for all programsConsider requiring participation in other
databases – ACC, SVSPrepare for substantial costs to get
actionable individual level dataWill need to educate publicMust consider remedial actions for low
performersCurrently, most likely a tool for professionals