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Ann Thorac Surg 2000;70:695-701
© 2000 The Society of Thoracic Surgeons

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Original articles: cardiovascular

Washington State’s model of physician leadership in cardiac outcomes reporting

University of Washington, Seattle, USA
Washington State Health Care Authority, Olympia, USA
Cardiac Surgery and Outcomes Research, Everett, USA
St. Joseph Medical Center, Tacoma, USA
University of Washington, Seattle, USA
Providence Medical Center, Seattle, USA
Virginia Mason Medical Center, Seattle, USA
Washington and Mid America Heart Institute, Kansas City, Missouri, USA

Address reprint requests to Dr Goss, 325 Ninth Ave, Box 359780, Seattle, WA 98104
e-mail: rgoss{at}u.washington.edu

Background. In 1993, the cardiac surgery community in Washington State opposed an effort by the state Health Care Authority (HCA) to identify "centers of excellence" for selective contracting of coronary artery bypass grafting (CABG) procedures, and proposed an alternate model that would create a statewide cardiac outcomes registry under physician governance to be used by all institutions for internal quality improvement activities.

Methods. A prospective pilot data collection effort, which examined preoperative and postoperative patient-reported health status, served as the basis for evaluating the capacity of a physician-led organization to develop a collaborative atmosphere and facilitate universal hospital participation.

Results. A surgical steering group met on a regular basis and reached consensus on governance issues, protocols for standardized data collection, and policies regarding data dissemination. All 14 centers that performed bypass surgery in the state participated. Patients who were surveyed reported statistically significant improvements in physical, emotional, and anginal-specific health status after bypass surgery. Baseline patient characteristics and longitudinal outcomes were compared across institutions.

Conclusions. Based on the feasibility of this collaborative outcomes reporting program, the HCA revised its policy regarding selective contracting and has helped to support an ongoing physician-led and -governed cardiac outcomes reporting system that is particularly notable for the subsequent integration of both CABG surgery and catheterization-based procedures into one standardized registry.

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