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Ann Thorac Surg 1997;64:1229
© 1997 The Society of Thoracic Surgeons
President, The Society of Thoracic Surgeons
The Society's volunteer multiinstitutional database, organized 10 years ago, is a unique endeavor in that other surgical databases generally have been involuntary, or if voluntary, have been for individual institutions or groups of institutions with similar interests. From the beginning it was recognized that there would be a number of challenges associated with this type of database, eg, incomplete data entry, difficulty in data verification, and maintaining anonymity of patients, surgeon, and institution. Most of these now have been addressed successfully. The STS database has grown to include almost one million patients from more than 540 participating groups. Initially nurtured by Richard E. Clark, this undertaking in some respects is analogous to the current Society information initiative—the development of the STS and CTS Web sites—which has been enthusiastically championed by Robert L. Replogle.
The key word in both endeavors is information. However, what is most important is not the acquisition of data, but rather what is done with them. Data are useless unless they are analyzed to provide derived information from which informed decisions can be made. Simply observing unanalyzed data is analogous to observing a painting, a landscape, or a cloud formation. Although one may derive cultural benefit from observing their beauty, a critical analysis will provide additional information. For example, analysis of a cloud formation may allow prediction of future weather conditions. In a similar fashion, simple data accumulation and recording is not sufficient. This is not meant to imply that acquisition of accurate data is unimportant, but only to indicate that this is just the first, albeit crucial, step in data analysis. Risk stratification and hospital mortality are relatively primitive analyses. Other analyses such as those dealing with quality, cost, efficiency, and satisfaction are and will continue to be sought and required by patients, payors, and regulating agencies. One need only to recognize the regulatory efforts of New York, Pennsylvania, and the Health Care Financing Administration to understand what has been occurring. Similar efforts are underway in California and Ohio. The data required by managed care organizations or for health care services contracts confront us on an almost daily basis, further emphasizing the importance of accurately analyzed information.
We can learn from industry, where their analytic techniques predict outcomes and analyze variances to select the most efficient process for providing the best product at the lowest cost in human and financial resources. This is the means by which industry survives in a competitive market. We are similar, but not identical. Although cost is important, quality is foremost. In industry a poor quality product will not sell, or if it does, only poorly. For us, poor quality service may result in unsatisfactory outcome. Even with excellent quality the outcome may be less than desirable because we are dealing with the inexact nature of medical practice.
These then are the demands of those who receive, those who pay for, and those who regulate delivery of our services. It is important that we supply the data and the analyses that are accurate, precise, and appropriate. If we do not, it will be done for us by others in a possibly unscientific and unsatisfactory manner. We have prided ourselves on our self-imposed criteria for excellence and self-regulation. We have always analyzed our results, and presented and published them to improve the quality of the care of our patients. Peer review is essential to the integrity of this process. What currently is required is basically no different than what we have done over the ages, except that there is now a demand that the information be uniformly acquired, analyzed, and supplied to all who request it.
Because this issue is so vital to our future we have planned a panel presentation during a plenary session of the next annual scientific meeting that will deal with the future directions of databases. In my estimation this will be the next great issue facing our specialty and potentially will have an influence as great as RBRVS. If we do not consider the future, we cannot prepare for it. Dreaming of the future and devising improvements in techniques and delivery of care to our patients is inherent to our specialty. Dealing with the future may be risky and anxiety producing. It is more comfortable to stay with what one has been accustomed to. However, we characteristically have been risk takers in pushing forward the frontiers of medical science, research, and delivery of patient care. I am confident we will meet this next challenge with the same ingenuity, tenacity, and integrity as we have in the past.
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Address reprint requests to Dr Kaiser, Division of Cardiothoracic Surgery, St. Louis University Medical Center, 3635 Vista Ave, PO Box 15250, St. Louis, MO 63110-0250.
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