HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dziuban, S. W. Articles by Dal Col, R. H. Search for Related Content PubMed PubMed Citation Articles by Dziuban, S. W., Jr Articles by Dal Col, R. H.

The Annals of Thoracic Surgery, Vol 58, 1871-1876, Copyright © 1994 by The Society of Thoracic Surgeons

ARTICLES

How a New York cardiac surgery program uses outcomes data

SW Dziuban Jr, JB McIlduff, SJ Miller and RH Dal Col
St. Peter's Hospital, Albany, NY.

In New York State, a risk-adjusted outcomes system has been used by the Department of Health to monitor all cardiac operations since January 1989. Hospital-specific and physician-specific results are published annually. In this report we describe the experience of one hospital in New York State whose results showed a higher than expected surgical mortality. Staff reactions were initially skeptical, and case reviews found no quality-of-care problems. However, a different approach using statistical analysis of the detailed case-specific outcomes data was more revealing. The excess mortality was localized to patients having high-acuity, emergency coronary artery bypass grafting, particularly those who had suffered a preoperative acute myocardial infarction less than 6 hours before, those who were in shock, or those who were in a hemodynamically unstable condition. The staff responded with a focused effort to optimize the management of these patients, resulting in zero mortality for emergency coronary artery bypass grafting during the following year. In the process, staff from all departments joined together in a more collaborative approach to the cardiac surgery program. Outcomes data can be useful for effecting program improvement if comparable norms and open access for flexible analysis are available.

This article has been cited by other articles:

				W. H. Ettinger, S. M. Hylka, R. A. Phillips, L. H. Harrison Jr, J. A. Cyr, and A. J. Sussman When Things Go Wrong: The Impact of Being a Statistical Outlier in Publicly Reported Coronary Artery Bypass Graft Surgery Mortality Data American Journal of Medical Quality, April 1, 2008; 23(2): 90 - 95. [Abstract] [PDF]

				C. H. Fung, Y.-W. Lim, S. Mattke, C. Damberg, and P. G. Shekelle Systematic Review: The Evidence That Publishing Patient Care Performance Data Improves Quality of Care Ann Intern Med, January 15, 2008; 148(2): 111 - 123. [Abstract] [Full Text] [PDF]

				A. C. Enthoven, F. J. Crosson, and S. M. Shortell 'Redefining Health Care': Medical Homes Or Archipelagos To Navigate? Health Aff., September 1, 2007; 26(5): 1366 - 1372. [Abstract] [Full Text] [PDF]

				A. J. Epstein Do cardiac surgery report cards reduce mortality? Assessing the evidence. Med Care Res Rev, August 1, 2006; 63(4): 403 - 426. [Abstract] [PDF]

				R. E. Herzlinger and R. Parsa-Parsi Consumer-Driven Health Care: Lessons From Switzerland JAMA, September 8, 2004; 292(10): 1213 - 1220. [Abstract] [Full Text] [PDF]

				M. N. Marshall, P. G. Shekelle, H. T.O. Davies, and P. C. Smith Public Reporting On Quality In The United States And The United Kingdom Health Aff., May 1, 2003; 22(3): 134 - 148. [Abstract] [Full Text] [PDF]

				R. Galvin and A. Milstein Large Employers' New Strategies in Health Care N. Engl. J. Med., September 19, 2002; 347(12): 939 - 942. [Full Text] [PDF]

				N. Gupta, P. L. Kotler, and R. A. Dudley Considerations in the Development of Intensive Care Unit Report Cards J Intensive Care Med, September 1, 2002; 17(5): 211 - 217. [Abstract] [PDF]

				M. R. Chassin Achieving And Sustaining Improved Quality: Lessons From New York State And Cardiac Surgery Health Aff., July 1, 2002; 21(4): 40 - 51. [Abstract] [Full Text] [PDF]

				D. M. Shahian, S.-L. Normand, D. F. Torchiana, S. M. Lewis, J. O. Pastore, R. E. Kuntz, and P. I. Dreyer Cardiac surgery report cards: comprehensive review and statistical critique Ann. Thorac. Surg., December 1, 2001; 72(6): 2155 - 2168. [Abstract] [Full Text] [PDF]

				E. C. Becher and M. R. Chassin Improving The Quality Of Health Care: Who Will Lead? Health Aff., September 1, 2001; 20(5): 164 - 179. [Abstract] [Full Text] [PDF]

				E. A. Halm and M. R. Chassin Why Do Hospital Death Rates Vary? N. Engl. J. Med., August 30, 2001; 345(9): 692 - 694. [Full Text] [PDF]

				W. L. Holman, R. M. Allman, M. Sansom, C. I. Kiefe, E. D. Peterson, K. J. Anstrom, S. S. Sankey, S. G. Hubbard, R. G. Sherrill, and for the Alabama CABG Study Group Alabama Coronary Artery Bypass Grafting Project: Results of a Statewide Quality Improvement Initiative JAMA, June 20, 2001; 285(23): 3003 - 3010. [Abstract] [Full Text] [PDF]

				E C Schneider and T Lieberman Publicly disclosed information about the quality of health care: response of the US public Qual. Saf. Health Care, June 1, 2001; 10(2): 96 - 103. [Abstract] [Full Text] [PDF]

				B. J. Harlan Statewide reporting of coronary artery surgery results: A view from California J. Thorac. Cardiovasc. Surg., March 1, 2001; 121(3): 409 - 417. [Full Text] [PDF]

				M. N. Marshall, P. G. Shekelle, S. Leatherman, and R. H. Brook The Public Release of Performance Data: What Do We Expect to Gain? A Review of the Evidence JAMA, April 12, 2000; 283(14): 1866 - 1874. [Abstract] [Full Text] [PDF]

				J. H. Burack, P. Impellizzeri, P. Homel, and J. N. Cunningham Jr Public reporting of surgical mortality: a survey of New York State cardiothoracic surgeons Ann. Thorac. Surg., October 1, 1999; 68(4): 1195 - 1200. [Abstract] [Full Text] [PDF]

				S. W. Dziuban Jr Using database information in your clinical practice Ann. Thorac. Surg., August 1, 1999; 68(2): 350 - 352. [Abstract] [Full Text] [PDF]

				J Poloniecki, O Valencia, and P Littlejohns Cumulative risk adjusted mortality chart for detecting changes in death rate: observational study of heart surgery BMJ, June 6, 1998; 316(7146): 1697 - 1700. [Abstract] [Full Text]

				M. R. Chassin, E. L. Hannan, and B. A. DeBuono Benefits and Hazards of Reporting Medical Outcomes Publicly N. Engl. J. Med., February 8, 1996; 334(6): 394 - 398. [Full Text]

				F. L. Grover, K. E. Hammermeister, and A. L. W. Shroyer Quality Initiatives and the Power of the Database: What They Are and How They Run Ann. Thorac. Surg., November 1, 1995; 60(5): 1514 - 1521. [Full Text]