Public Reporting of Cardiovascular Data

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 EffectivenessWhat is being comparedWhat are the metrics of comparisonWho is performing the comparison

National Cardiovascular Data Registry

1998

Cath PCI Registry1380 sites11 million patients

2005

ICD Registry1590 sites>600K patients

2008

Action Registry656 sites225K patientsPinnacle800 sites/ 1.9 million patients

2012-future

Structural Heart“TAVR”Atrial Fibrillation

STS National Database1990

Adult Cardiac Surgery Database

1994

Adult Aortic and Mitral ValvesAdult Thoracic

2002

Adult Congenital Heart Surgery

> 90 % of Cardiothoracic Surgery Practices participate in database

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

STSThe 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)

Important Feedback for Program Results

Both registries are risk adjusted data

ACC-NCDR Sample Report

Blank Data Collection Form

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

Complexity of Public Reporting

ACC-AHA,AHRQ Public Reporting Consensus Statement

Risk adjustedTimelySufficient in sample sizeIncrease value to consumers and providersInclude a relevant time periodEasy to useProvide explanations and methodology

Above all information must be valid and reliable

1. 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

2. 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

reportingParticipate in a federally accredited PSOOnly requested risk adjusted outcomes data

providedRequire a valid inter-rater reliability processMandatory vs. voluntary reportingSTS presently physician owned data and

would require further processing

Public Reporting PrinciplesRisk Adjusted data only Focus on vital few vs useful many

No more than 3-5 measuresClear and ConciseEstablish a valid Inter-rater reliability

processTimely (concurrent abstracting or within 6

months)

What ACC measures are recommended?Door to Balloon timesPCI inhospital risk adjusted mortality (all

patients)Volumes (significant sample size)

Stemi (100)Elective Angioplasties (300)

Annual volume numbers onlyIf <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?