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Ann Thorac Surg 2005;80:799-801
© 2005 The Society of Thoracic Surgeons

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The statistician's page

Mandatory Database Participation: Risky Business?

^a Providence Health System, Portland, Oregon
^b Starr-Wood Cardiac Group of Portland PC, Portland, Oregon

Accepted for publication January 7, 2005.

^_* Address reprint requests to Dr Grunkemeier, Providence Health System, 9205 SW Barnes Rd, Suite 33, Portland, OR 97225 (Email: gary.grunkemeier@providence.org).

The first 300 words of the full text of this article appear below.

	Introduction

 
In this issue of The Annals, Shahian et al [1] chronicle the process of implementing a state-mandated comparison of the cardiac surgery programs in Massachusetts. They describe several "lessons" learned during their implementation experience. The results of this experiment are already available from the Massachusetts Data Analysis Center (Mass-DAC), whose web address is given in the paper [1]. One of the lessons is the mandatory statewide adoption of the Society of Thoracic Surgeons National Cardiac Database (STS NCD). The authors urge that this approach should be followed by every state. If that suggestion were implemented, it would comprise mandatory universal adoption of the STS NCD; a seemingly laudable goal ... or is it?

	The Heart of Continuous Quality Improvement and Report Cards

 
The authors distinguish between two pathways for improving the outcomes of cardiac surgery: continuous quality improvement (CQI) and cardiac report cards. They admit that CQI has "the greatest potential for real and sustained quality improvement," but it is an internal process, and since the "demand for public accountability" must eventually be met, the report card method was selected. Risk-adjusted comparisons are the heart of both CQI and report cards. Table 1 shows that the steps involved in producing them involves collaboration among the individual hospitals (LOCAL) and the independent coordinating center (CENTRAL), and are the same for both CQI and report cards up to the last step. "Adoption of the STS NCD" could arguably be implemented at three different levels:

(A) Use the STS data collection forms, and create new risk models with those variables to produce reports.

(B) Use the STS data form and use their published risk models to do the analysis and reporting.

(C) Full participation: submit data to STS database and use the Duke Clinical Research Institute (DCRI) analyses and reports.