Washington State's model of physician leadership in cardiac outcomes reporting

Area of Science:

• Health Services Research
• Quality Improvement Science
• Cardiac Surgery Outcomes

Background:

• Washington State cardiac surgeons opposed a 1993 Health Care Authority (HCA) initiative for "centers of excellence" in coronary artery bypass grafting (CABG).
• An alternative physician-governed statewide cardiac outcomes registry model was proposed for internal quality improvement.

Purpose of the Study:

• To evaluate the feasibility of a physician-led organization in fostering collaboration and universal hospital participation for a cardiac outcomes registry.
• To assess the capacity for developing a collaborative atmosphere and facilitating hospital-wide engagement.

Main Methods:

• A prospective pilot data collection initiative focused on patient-reported preoperative and postoperative health status.
• Establishment of a surgical steering group to reach consensus on governance, data collection protocols, and dissemination policies.
• Universal participation from all 14 state centers performing bypass surgery.

Main Results:

• Statistically significant improvements in patient-reported physical, emotional, and anginal-specific health status post-CABG surgery.
• Successful consensus on governance, data collection, and dissemination policies by the surgical steering group.
• Comparison of baseline patient characteristics and longitudinal outcomes across participating institutions.

Conclusions:

• The collaborative outcomes reporting program proved feasible, leading the HCA to revise its selective contracting policy.
• The initiative supported an ongoing physician-led and -governed cardiac outcomes reporting system.
• The registry successfully integrated both CABG surgery and catheterization-based procedures into a standardized system.