QualityPath™ Cardiac Bypass (CABG) Criteria – DRAFT
QualityPath™ CABG PHYSICIAN AND FACILITY EVALUATION CRITERIA
Criteria
Registry Participation Facility
Rationale
Physicians need timely, accurate
and clinically relevant information
to improve patient outcomes,
determine appropriate care, engage
patients in decision-making and be
good stewards of scarce resources.
Definition/Action
To be eligible for QualityPath™
designation, a facility must
participate in The Society of
Thoracic Surgeons Adult Cardiac
Surgery Database
http://www.sts.org/nationaldatabase
Registry Participation Surgeon
Physicians need timely, accurate
and clinically relevant information
to improve patient outcomes,
determine appropriate care, engage
patients in decision-making and be
good stewards of scarce resources.
To be eligible for QualityPath™
designation, a physician must
participate in The Society of
Thoracic Surgeons Adult Cardiac
Surgery Database
Meets
Provide STS Facility Dashboard to
QualityPath™ to confirm registry
participation
Briefly describe how facility uses
registry data to work together with
physicians to improve quality.
Provide physician specific STS
Dashboard to QualityPath™ to
confirm registry participation and
facilitate collection of metrics listed
below under transparency.
http://www.sts.org/nationaldatabase
Transparency – Facility
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Consumers have a right to know
about differences in cost and
quality between health care
facilities, physicians and other
clinicians; and a responsibility to
educate themselves about these
differences as part of making health
care decisions.
To be eligible for QualityPath™
designation the following results for
all CABG procedures must be
reported to QualityPath™ by facility

CABG case volume for each
of the past two calendar
years

STS CABG Composite Score
Results available to QualityPath™
Results at or better than average
compared to STS national averages
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Criteria
Rationale
Definition/Action
 Absence of Operative
Mortality

Transparency –
Surgeon
Transparency –
Affiliated/referring
primary care physician
practice(s)
Consumers have a right to know
about differences in cost and
quality between health care
facilities, physicians and other
clinicians; and a responsibility to
educate themselves about these
differences as part of making health
care decisions.
Managing cardiovascular risk
factors well in patients with known
cardiovascular disease decreases
their likelihood of suffering serious
complications.
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Absence of Major Morbidity
To be eligible for QualityPath™
designation the following results for
all CABG procedures must be
reported to QualityPath™ by
practice group and by individual
surgeon

CABG case volume for each
of the past two calendar
years

STS CABG Composite Score

Absence of Operative
Mortality

Absence of Major Morbidity
To be eligible for QualityPath™
designation affiliated/referring
primary care practices must
participate in public reporting by
clinic site of:
 Optimal Diabetes Care (A1c,
LDL, BP control, aspirin use, no
tobacco use)

Meets
Results available to QualityPath™
Results at or better than average
compared to STS national averages
Results publicly available through
QualityPath™ or other designated
venue
Results at or better than average
Optimal Cardiovascular Disease
2
Criteria
Rationale
Definition/Action
(CVD) Care (LDL, BP control,
aspirin use, no tobacco use)
Meets
Standardize clinical
processes – Decision
support for ordering
diagnostic cardiac
imaging tests
Decision support provides
immediate help determining the
best diagnostic imaging test based
on a patient’s indication and
available evidence and best
practice. It helps physicians order
the right test the first time, saving
the cost of unnecessary or low
utility tests.
To be eligible for QualityPath™
designation Decision Support when
ordering cardiac diagnostic imaging
tests must be used consistently by
the surgery practice and
affiliated/referring primary care
practice(s).
Describe the Decision Support
process
http://www.medcurrent.com/JACR
_Jan_2011__Effectiveness_of_Clinical_Decision
_Support_in_Controlling_Inappropr
iate_Imaging.pdf
Standardize clinical
processes - Patients
actively engaged in
shared decision
making using a high
quality decision aid
Shared decision making ensures
that patients are informed of all
options for treating their condition
prior to the procedure, that they
understand the risks and benefits of
each option, and that they want to
proceed with a CABG.
Results must be tracked and
reported by individual clinician, by
practice, and by facility
To be eligible for QualityPath™
designation the surgery practice
must engage all patients in shared
decision making process using a
high quality decision aid that
includes optimal medical therapy as
one treatment option.
Specific Decision support tool used
provided to QualityPath™
Results provided to QualityPath™
by individual clinician, by group
practice, and by facility
Describe the shared decision
making process
Decision aid provided to
QualityPath™
Results available to QualityPath™
Proportion of CABG patients
participating in shared decision
making tracked
Multiple decision aid options are
available at:
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Criteria
Rationale
Definition/Action
http://decisionaid.ohri.ca/AZinvent.
php
Meets
Standardize Clinical
Processes - Quality of
patient decision
making assessed using
a standardized
instrument
Assessing the quality of shared
decision making prior to CABG
helps identify gaps in patient’s
understanding and the extent to
which the patient was actively
engaged in deciding to have CABG.
To be eligible for QualityPath™
designation the quality of patient
decision making must be assessed
prior to CABG, for all patients, using
a standardized instrument
Describe the process for evaluating
the quality of shared decision
making
Proportion of CABG patients
completing assessment of decision
quality tracked
Instrument used to assess decision
quality provided to QualityPath™
Results available to QualityPath™
Example is available at:
http://www.massgeneral.org/decisi
onsciences/assets/pdfs/CAD_DQI_S
V.pdf
Standardize Clinical
Processes –
Conversation about
future care needs
Spelling out what kind of medical
care we want if we are too ill or
hurt to express our wishes is a way
of telling our wishes to family,
friends, and health care
professionals to avoid confusion
later on.
To be eligible for QualityPath™
Results available to QualityPath™
designation there must be a process
in place to ensure a conversation
about future care needs is
documented in an Advanced
Directive
Proportion of patients with
conversation documented in an
Advanced Directive is tracked
Disclose potential
conflicts of interest –
Facility
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Full disclosure of potential conflicts
of interest helps ensure treatment
decisions are not influenced by
commercial interests
To be eligible for QualityPath™
designation the facility must have a
policy on industry conflict of
interest in place that includes full
Policy provided to QualityPath™
Example of patient disclosure (e.g.
hard copy report or website link)
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Criteria
Disclose potential
conflicts of interest Surgeon
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Rationale
Full disclosure of potential conflicts
of interest helps ensure treatment
decisions are not influenced by
commercial interests
Definition/Action
disclosure to patients
Meets
provided to QualityPath™
All direct and indirect industry
payments must be tracked by
facility
Direct and Indirect payments
provided to QualityPath™ annually
To be eligible for QualityPath™
designation the surgery practice
must have a policy on industry
conflict of interest in place that
includes full disclosure to patients
Policy provided to QualityPath™
All direct and indirect industry
payments must be tracked by
individual surgeon
Direct and Indirect payments
provided to QualityPath™ annually
Example of patient disclosure (e.g.
hard copy report or website link)
provided to QualityPath™
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