Report of the STS Quality Measurement Task ForceQuality Measurement in Adult Cardiac Surgery: Part 1—Conceptual Framework and Measure Selection
Section snippets
Executive Summary
The Society of Thoracic Surgeons established a Quality Measurement Task Force to develop a methodology for the comprehensive assessment of adult cardiac surgery quality of care, including both individual measures and an overall composite quality score. In Part 1 of a two-part series, the Task Force describes the conceptual framework, principles, and guidelines used to select and categorize the individual measures that comprise the composite score.
Quality indicators were selected using the
The Concept of Quality
Quality is an abstract construct that cannot be directly measured. In the nomenclature of modern measurement theory, it is characterized by one or more latent (unobserved) variables or traits. The overt, observable manifestations of such underlying traits may be intuitively apparent at the extremes, but difficult to quantify over the broad range between extremes. Different observers may agree that a luxury automobile is high quality, and that an entry-level automobile is of lower quality.
Cardiac Surgery Quality
Cardiac surgeons were early adopters of data collection, measurement, and analysis. Their dominant procedure, CABG, is the most commonly performed of all complex operations. It is costly and has broad implications for population health. CABG surgery is the paradigm for outcome measurement given both its frequency and its potential for serious morbidity and mortality.
In recognition of its important public health implications, the National Quality Forum (NQF) recently convened a Cardiac Surgery
Principles for Measure Selection
After extensive investigation and discussion, the QMTF established the following principles for the development of a comprehensive quality rating system for cardiac surgery:
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Initial public quality reports should focus on programs, not individual surgeons. Although a number of states, notably New York and Pennsylvania, publish surgeon-specific results, this continues to be a highly controversial topic. Performance reports on individual practitioners are fraught with even more vexing conceptual
Specific Measure Selection
In addition to these nine major principles, the QMTF also considered evolving new trends in health care quality assessment, including the use of bundled measures and “all or none” scoring as advocated by the Institute for Healthcare Improvement and the Institute of Medicine [1, 37]. Consider a bundle of care measures for a particular condition, such as acute myocardial infarction. If experts agree that all components of this bundle (eg, aspirin after acute myocardial infarction, β-blockade,
Conclusion
The QMTF selected a set of 11 individual quality measures within four domains of care. These are nationally recognized metrics that are also consistent with the guiding principles established by the STS QMTF. This measure set will be the foundation for a comprehensive, composite quality scoring methodology for cardiac surgery. The QMTF envisions this as a dynamic process that will undergo progressive refinements over time.
Part 2 of this report describes the statistical considerations for
References (51)
- et al.
Cardiac surgery report cards: comprehensive review and statistical critique
Ann Thorac Surg
(2001) - et al.
Cardiac surgery risk models: a position article
Ann Thorac Surg
(2004) - et al.
Measuring the quality of surgical care: structure, process, or outcomes?
J Am Coll Surg
(2004) - et al.
The volume-outcome relationship: from Luft to Leapfrog
Ann Thorac Surg
(2003) - et al.
No continuous relationship between Veterans Affairs hospital coronary artery bypass grafting surgical volume and operative mortality
Ann Thorac Surg
(1996) - et al.
Public reporting of surgical mortality: a survey of New York State cardiothoracic surgeons
Ann Thorac Surg
(1999) - et al.
Prediction of operative mortality after valve replacement surgery
J Am Coll Cardiol
(2001) - et al.
Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in Northern New England
Ann Thorac Surg
(2004) - et al.
Risk models for cardiac valve surgery
ACC Curr J Rev
(2005) - et al.
Use of administrative data for clinical quality measurement
J Thorac Cardiovasc Surg
(2005)
Does reporting of coronary artery bypass grafting from administrative databases accurately reflect actual clinical outcomes?
J Thorac Cardiovasc Surg
Validity of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database
Ann Thorac Surg
Statin initiation following coronary artery bypass grafting: outcome of a hospital discharge protocol
Chest
Criteria by which to evaluate risk-adjusted outcomes programs in cardiac surgery
Ann Thorac Surg
Secondary prevention after coronary bypass: the American Heart Association “Get with the Guidelines” program
Ann Thorac Surg
The Society of Thoracic Surgeons practice guideline series: aspirin and other antiplatelet agents during operative coronary revascularization
Ann Thorac Surg
Role of statin therapy in the coronary bypass patient
Ann Thorac Surg
Cardiac medical therapy in patients after undergoing coronary artery bypass graft surgery: a review of randomized controlled trials
J Am Coll Cardiol
Quality measurement in adult cardiac surgery: Part 2—Statistical considerations in composite measure scoring and provider rating
Ann Thorac Surg
Performance measurement: accelerating improvement
Improving cardiac surgery quality—volume, outcome, process?
JAMA
Surgical mortality as an indicator of hospital quality: the problem with small sample size
JAMA
Hospital volume and surgical mortality in the United States
N Engl J Med
Procedural volume as a marker of quality for CABG surgery
JAMA
American College of Cardiology/American Heart Association clinical practice guidelines: Part I: where do they come from?
Circulation
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Dr Shahian is the Quality Measurement Task Force Chair and Writing Group Leader.