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Assessing clinical performance in cardiac surgery. Does a specialised clinical database make a difference?

Daniela Fortuna¹, Maria Vizioli, Andrea Contini

¹Department of Clinical Governance, Agenzia Sanitaria Regionale, Viale Aldo Moro, 21, 20147 Bologna, Italy.

Interactive Cardiovascular and Thoracic Surgery

|August 3, 2007

Summary

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Administrative and specialized clinical databases produce similar cardiac surgery mortality rankings. Both methods effectively identify top-performing and lower-performing centers for quality assessment.

Area of Science:

Health Services Research
Medical Informatics
Cardiac Surgery Outcomes

Background:

Hospital performance assessment relies on accurate data.
Cardiac surgery centers are often ranked using mortality league tables.
The source of data (administrative vs. clinical) may influence these rankings.

Purpose of the Study:

To compare cardiac surgery mortality league tables derived from administrative and specialized clinical databases.
To assess the agreement between rankings generated by the two data sources.
To evaluate the utility of administrative data for performance monitoring in cardiac surgery.

Main Methods:

Compared mortality league tables from administrative and clinical databases for six cardiac surgery centers.

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Utilized data from 4017 patients undergoing cardiac surgery in 2003.

Employed case-mix adjusted in-hospital mortality rates and Spearman correlation coefficient to assess agreement.

Main Results:

Both administrative and clinical databases produced highly correlated league tables (r=0.89, P<0.02), identifying the same best and worst performing centers.
Using logistic EuroSCORE instead of additive EuroSCORE did not alter the findings.
An administrative database and a specialized clinical database provided similar mortality rankings.

Conclusions:

Administrative and clinical databases yield comparable results for cardiac surgery center performance assessment.
While administrative data offer efficiency, clinical databases are crucial for direct surgical staff involvement in quality monitoring.
Both data types serve distinct but complementary roles in ensuring quality healthcare.