Evaluating Quality in Adult Cardiac Surgery

Abstract

National and institutional quality initiatives provide benchmarks for evaluating the effectiveness of medical care. However, the dramatic growth in the number and type of medical and organizational quality-improvement standards creates a challenge to identify and understand those that most accurately determine quality in cardiac surgery. It is important that surgeons have knowledge and insight into valid, useful indicators for comparison and improvement. We therefore reviewed the medical literature and have identified improvement initiatives focused on cardiac surgery. We discuss the benefits and drawbacks of existing methodologies, such as comprehensive regional and national databases that aid self-evaluation and feedback, volume-based standards as structural indicators, process measurements arising from evidence-based research, and risk-adjusted outcomes. In addition, we discuss the potential of newer methods, such as patient-reported outcomes and composite measurements that combine data from multiple sources.

Keywords: Coronary artery bypass/economics/mortality/statistics & numerical data; databases, factual/history/standards/statistics & numerical data; delivery of health care, integrated; health information exchange/trends; outcome and process assessment, health care/classification/economics/methods/standards/trends; practice guidelines as topic; program evaluation; quality assurance, health care/organization & administration; quality indicators, health care/standards; risk adjustment.