Overview
Public Reporting
Cardiovascular Data
Recommendations
Healthcare providers need reliable quality and comparative
performance information to advance their quality improvement
efforts.
Consumers need reliable information to make informed decisions
about their care.
Comparative Effectiveness
 What is being compared
 What are the metrics of comparison
 Who is performing the comparison
National Cardiovascular Data
Registry
1998
Cath PCI
Registry
1380 sites
11 million
patients
2005
ICD Registry
2008
1590 sites
Action Registry
>600K patients
656 sites
225K patients
Pinnacle
800 sites/ 1.9
million patients
2012-future
Structural Heart
“TAVR”
Atrial Fibrillation
STS National Database
1990
Adult Cardiac
Surgery Database
1994
Adult Aortic and
Mitral Valves
Adult Thoracic
2002
Adult Congenital
Heart Surgery
> 90 % of Cardiothoracic Surgery Practices participate in database
Important Feedback for Program
Results
NCDR
Executive summary of quarterly
institutional outcomes reports and
on the dashboard, metrics and
measures provides information
about quality of care.
These metrics and measures
represent the most important
processes and outcomes of care with
a strong link to evidence and
clinical guidelines
STS
The star rating calculation
begins by assuming all
providers are average and
then determines statistically
if there is at least a 99
percent probability that the
performance of any specific
provider is lower than
average (one star) or higher
than average (three star)
Both registries are risk adjusted data
ACC-NCDR
Blank Data Collection Form
Sample Report
Complexity of Public Reporting
Healthcare providers
Consumers
Have a track record as effective
champions for performance excellence
and support public reporting in
principle.
May be misled by findings of a report or
by media interpretation (e.g.
Healthgrades where only Medicare
billing data is compiled)
Invest significantly in the data
abstraction necessary for report card
formulation. However, much variability
in coding of complications (not
concurrent). Significant concerns exist
over how inter-rater reliability will be
achieved.
Could have difficulty understanding
clinical jargon and graphical
interpretation of data.
(oversimplification can be misleading as
well)
Are concerned with impact public
reporting will have on public health (as
physicians will become risk averse)
Can be confused by lack of report card
standardization and receive conflicting
information
Understand that report cards are a
snapshot of care and that there is no
“perfect” report card
May find websites difficult to navigate
and have difficulty in accessing
information about methodology and
limitations of a report card
ACC-AHA,AHRQ Public Reporting
Consensus Statement
Risk adjusted
Timely
Sufficient in sample size
Increase value to consumers and providers
Include a relevant time period
Easy to use
Provide explanations and methodology
Above all information must be valid and reliable
1.
2.
Krumholz et al, Standards for Statistical Models Used for Public Reporting of Health Outcomes. An American Heart Association Scientific Statement From
the Quality of Care and Outcomes Research Interdisciplinary Writing Group. Circulation 2005 doi:10.1161/CIRCULATIONAHA.105.170769
Hibbard J, Sofaer S. Best Practices in Public Reporting No. 2: Maximizing Consumer Understanding of Public Comparative Quality Reports: Effective Use
of Explanatory Information. AHRQ Publication No. 10-0082-EF, May 2010,
Public Reporting
Recommendations
 Supportive of transparency and public reporting
 Participate in a federally accredited PSO
 Only requested risk adjusted outcomes data provided
 Require a valid inter-rater reliability process
 Mandatory vs. voluntary reporting
 STS presently physician owned data and would require
further processing
Public Reporting Principles
 Risk Adjusted data only
 Focus on vital few vs useful many
 No more than 3-5 measures
 Clear and Concise
 Establish a valid Inter-rater reliability process
 Timely (concurrent abstracting or within 6 months)
What ACC measures are
recommended?
 Door to Balloon times
 PCI inhospital risk adjusted mortality (all patients)
 Volumes (significant sample size)
 Stemi (100)
 Elective Angioplasties (300)
 Annual volume numbers only
 If <100 Stemi– report “inadequate sample size to be
reported”
 If <300 Elective PCI – report “inadequate sample size to
be reported”
What STS measures are
recommended?
 CABG only (no redo’s)
 Mortality (as observed/expected)
 CABG Volumes (significant sample size)
 Annual volume numbers only
 If <100 CABG– report “inadequate sample size to be
reported”
 *Indicate programs that provide Heart Transplant
services*
Questions?