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The Veterans Affairs Continuous Improvement in Cardiac Surgery Study
F L Grover1, R R Johnson, A L Shroyer
1Division of Cardiology, University of Colorado Health Sciences Center, Denver.
The Annals of Thoracic Surgery
|December 1, 1994
Summary
The Department of Veterans Affairs Cardiac Surgery Consultants Committee improves cardiac surgery quality by reviewing mortality data. This feedback loop led to a significant reduction in observed-to-expected operative mortality ratios over seven years.
Area of Science:
- Cardiovascular Surgery
- Quality Improvement in Healthcare
- Health Services Research
Background:
- The Department of Veterans Affairs (VA) Cardiac Surgery Consultants Committee oversees quality of care at 43 VA cardiac surgical centers.
- Reviewing unadjusted and risk-adjusted operative mortality and perioperative complications is central to their quality assessment.
- Data are reviewed semiannually, with hospital-specific findings shared with program directors.
Purpose of the Study:
- To assess the impact of a quality improvement program utilizing risk-adjusted outcomes in cardiac surgery.
- To evaluate the effectiveness of feedback mechanisms on surgical quality and patient outcomes.
Main Methods:
- Semiannual review of unadjusted and risk-adjusted operative mortality data and perioperative complications.
- Prospective clinical decision-making informed by estimated relative risk of death for patient risk factors.
- Site visits and paper audits conducted when mortality rates increase.
- Feedback of quality improvement data to cardiothoracic surgeons and cardiologists.
Main Results:
- A significant reduction in the observed-to-expected operative mortality ratio over a 7-year period of utilizing risk-adjusted outcomes.
- Continuous feedback of quality improvement data likely contributed to this observed reduction.
Conclusions:
- The VA Cardiac Surgery Consultants Committee's quality review process, including risk-adjusted outcomes and data feedback, is associated with improved patient survival.
- Ongoing monitoring and constructive feedback are crucial for maintaining and enhancing the quality of cardiac surgical care.