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

Abstract

We compared mortality rates league tables for six cardiac surgery centres developed using an administrative database (integrated with information on patients' EuroSCORE) with those drawn from a specialised clinical database. Data from 4017 patients undergoing cardiac surgery over the period January 1st-December 31st 2003, and identified both databases were used. Case mix adjusted in-hospital mortality rates were estimated relying on information provided by each database, and league tables were drawn from both. The correlation between the two league tables was assessed through the Spearman correlation coefficient. League tables drawn from the two sources identified the same 'best' and 'worst' centres and the Spearman correlation coefficient confirmed a high level of agreement between the two rankings (r=0.89; P<0.02). Use of the logistic EuroSCORE instead of the additive one did not change the results. An administrative and a clinical specialised database provided similar league tables. However, this finding by no means implies that clinical databases should be abandoned. While administrative data allow a more efficient performance assessment, clinical databases may more properly satisfy the legitimate demand of surgical staff of being directly involved in quality monitoring, rather than being mere passive objects of external assessment.

P.Re.Val.E.: outcome research program for the evaluation of health care quality in Lazio, Italy

“…However, we did not find relevant changes in recording of co-morbidities in our study population over the years (data not shown). In agreement with previous reports, the prevalence of certain co-morbidities and risk factors was relatively low in our study population, indicating underreporting of co-morbidities and detailed clinical information in the administrative database [65]. However, underreporting was non-differential in the years included in our analysis.…”

“…However, underreporting was non-differential in the years included in our analysis. Moreover, a previous Italian study [65] assessing clinical performance in cardiac surgery demonstrated that the use of an administrative database provided similar league tables as a more complex specialized database.…”

Acute type A aortic dissection: significance of multiorgan malperfusion

“…The Emilia-Romagna Regional Registry of AAAD includes patients from different cardiothoracic regional centres as previously described [10]. Differences in patient management and operative In 154 patients (30.7%), the aortic repair was performed without circulatory arrest.…”

Reporting of Quality Indicators and Improvement in Hospital Performance: The P.Re.Val.E. Regional Outcome Evaluation Program

“…The prevalence of certain comorbidities was relatively low in our study population, indicating underreporting in the administrative database (Fortuna et al. ). However, underreporting was non‐differential in the years and regions included in our analysis.…”

“…A previous Italian study (Fortuna et al. ) demonstrated that an administrative database provided similar league tables as a more complex specialized database. Regarding the increase in timely PCI, we cannot exclude a “risk‐avoidance creep,” with hospitals selecting lower risk patients and avoiding higher risk ones.…”