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Public reporting of cardiac surgery performance: Part 2--implementation.
David M Shahian1, Fred H Edwards, Jeffrey P Jacobs
1Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. dshahian@partners.org
The Annals of Thoracic Surgery
|August 27, 2011
Summary
Creating a credible public reporting system requires careful implementation. Focusing on program-level data, using clear presentation, and employing appropriate statistical criteria are key for accurate provider performance assessment.
Area of Science:
- Health Services Research
- Public Health Policy
- Healthcare Quality Improvement
Background:
- Public reporting systems are crucial for healthcare accountability and quality improvement.
- Credibility of these systems hinges on appropriate data sources and reporting methodologies.
- Ensuring accurate interpretation of performance data is vital for informed decision-making.
Purpose of the Study:
- To outline essential components for establishing a credible public reporting system for healthcare providers.
- To discuss optimal data sources, metrics, and statistical approaches for performance classification.
- To provide guidance on presenting performance data effectively to the public.
Main Methods:
- Review of best practices in public reporting of healthcare performance.
- Discussion of data acquisition from audited clinical data registries.
- Analysis of various performance metrics including structure, process, outcomes, appropriateness, patient satisfaction, functional status, and health-related quality of life.
- Consideration of statistical criteria for provider performance classification.
- Emphasis on simplified visual or tabular presentation aids for public reports.
Main Results:
- Audited clinical data registries are ideal for data acquisition.
- Composite measures, appropriateness, patient satisfaction, functional status, and quality of life metrics are increasingly utilized.
- Statistical criteria must align with policy objectives and desired sensitivity/specificity.
- Simplified presentation aids enhance correct interpretation of numerical data.
- Program-level reporting is recommended over individual surgeon reporting due to sample size and to promote team-based care, potentially mitigating risk aversion.
Conclusions:
- Effective public reporting systems necessitate careful implementation, including data integrity, appropriate metrics, and clear presentation.
- Program-level reporting in areas like cardiac surgery is advisable to address sample size limitations and encourage comprehensive care.
- Statistical rigor and user-friendly data visualization are paramount for public trust and accurate understanding of provider performance.
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