Outcomes analysis, quality improvement, and patient safetyThe Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality
Section snippets
Brief Overview of the ACSD
As of September 2018, the ACSD includes 1,111 participant groups comprising 3,137 surgeons from all 50 United States states, 10 sites in Canada, and 22 participants in 9 other countries. There are 67 participants in the anesthesiology module comprising 627 anesthesiologists. An atrial fibrillation module closed at the end of 2017 after the expansion of atrial fibrillation–related data elements in the current version (version 2.9) of the ACSD.
The ACSD contains nearly 6.6 million cumulative
National Volume Trends and Outcomes in Adult Cardiac Surgery
The STS ACSD has developed risk-adjustment models 3, 4, 5 and composite quality ratings 13, 14, 15, 16 for seven major procedures: isolated CABG, isolated aortic valve replacement (AVR), AVR + CABG, mitral valve replacement (MVR), mitral valve (MV) repair, MVR + CABG, and MV repair + CABG. These seven operations, when added to the number of combined AVR + MVR and operations for thoracic aortic aneurysm, now account for 86% of procedures performed by cardiac surgeons annually (Fig 1). As in
Quality Measurement
The STS Quality Measurement Task Force (QMTF) develops STS risk models and performance measures. This process involves close collaboration between clinical cardiothoracic surgeons and statisticians from Duke Clinical Research Institute. Current QMTF projects related to Adult Cardiac Surgery are summarized below.
NQF Measure Submissions
In collaboration with QMTF, the STS TQI continues to support the development and maintenance of NQF-endorsed measures. There are now 35 STS quality measures endorsed by NQF. Of these, 15 previously endorsed measures (Table 3) will be reviewed for reendorsement in the coming months.
STS Quality Webinars
STS released the most recent in its webinar series on quality initiatives, “Renal Failure after Cardiac Surgery.” An expert panel of surgeons, anesthesiologists, and perfusionists explore the risks of acute kidney
Patient-Reported Outcomes
Patient-reported outcomes (PRO) are measures of patient physical and psychosocial well-being that are increasingly used in health care 28, 29, 30. PRO measures are reported directly by patients and may provide a more patient-centric way of assessing treatment outcomes. Several major organizations, such as the National Cancer Institute, American Cancer Society, Centers for Medicare and Medicaid Services, and the NQF have endorsed the incorporation of PRO into clinical care [31]. In addition, the
Informatics Task Force
The STS created the Informatics Task Force at the end of 2016 to provide a resource for advising the various STS databases on issues where computer science may have tools to improve the efficiency and accuracy of data collection and analysis. Medical informatics is the intersection of computer science and medical care. Topics the Informatics Task Force has investigated this past year include database specification upgrades for adult cardiac, use of “Health Level Seven International” (HL7)
Summary
Cardiothoracic surgeons have long recognized the value of scientific investigation and critical self-examination in advancing the quality, effectiveness, and the value of the care they provide for their patients. Nearly three decades ago the STS was one of the first specialty organizations to understand the importance of and to operationalize a comprehensive, accurate, and detailed clinical data registry to advance cardiothoracic surgical care. The ACSD is the keystone of the Society’s
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