External validation of compliance to perfusion quality indicators

There exists a significant gap between the expected and delivered level of quality received in America's hospitals. As a result, clinical outcomes of critical services such as coronary artery bypass graft (CABG) surgery have received unparalleled scrutiny. Medical information technology companies like Solucient and insurance carriers such as Blue Cross of California have identified and published a list of hospitals that demonstrate superior quality and patient outcomes for CABG procedures. These 'benchmark' programs serve as a reminder that closing the quality gap is possible. Unfortunately, none of these rankings (report cards) provide programs that fail to achieve benchmark status with detailed information on the processes or methods necessary to improve performance.

After identifying hospitals within the Fresenius Medical Care Extracorporeal Alliance (FMCEA) system that were judged as top performers (benchmark programs) by either Solucient ('100 Top Cardiovascular Hospitals', Evanston, IL 60201) or Blue Cross of California ('Centers of Expertise', Newbury Park, CA 91320), 12 months of continuous collection of CPB-related quality indicator data were analyzed for compliance to the FMCEA evidence-based Quality Indicator Program (QIP). A comparison of compliance to the FMCEA CPB indicators was made between the benchmark FMCEA hospitals and the FMCEA peer group hospitals.

Seven CPB process indicators were compared: 1) lowest sustained mean arterial pressure, 2) lowest sustained cardiac index, 3) lowest sustained mixed venous oxygen saturation, 4) lowest sustained hematocrit, 5) lowest activated clotting time, 6) highest sustained arterial blood temperature and 7) average sodium bicarbonate administered. Analysis of hospitals in the FMCEA system designated by Blue Cross of California as 'Centers of Expertise' revealed statistically significantly greater compliance (p < 0.05) in all but one CPB indicator. Hospitals in the FMCEA system designated by Solucient's '100 Top Cardiovascular Hospitals' listing revealed statistically significantly greater compliance to all but three CPB quality indicators.

Successful compliance with the majority of FMCEA CPB process indicators correlates with external recognition from two report card systems demonstrating superior hospital performance. Analysis of compliance to process indicators may provide useful guidelines to improve the standard of care in CABG surgery in many hospitals.