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Health Services Information: Lessons Learned from the Society of Thoracic Surgeons National Database

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Health Services Evaluation

Part of the book series: Health Services Research ((HEALTHSR))

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Abstract

The Society of Thoracic Surgeons (STS) National Database was initiated in 1989 with the goal of providing accurate clinical data to support quality assessment and improvement activities in cardiothoracic surgery. Participation among adult cardiac surgery centers and pediatric cardiac surgery centers in the USA currently exceeds 90 %, and the STS National Database now also includes a general thoracic surgery registry with growing national penetration.

The specific functions of the STS National Database have also evolved, as reflected in its various task forces. Quality assessment remains the primary function, and the STS Quality Measurement Task Force is responsible for developing risk models and performance metrics (often composites) for frequently performed cardiothoracic procedures. Each quarter, participants in the STS Adult Cardiac Database are provided with detailed feedback reports of their practice characteristics, including demographics, risk factor profiles, operative data, and outcomes benchmarked against STS national data. Similar feedback reports are provided to participants in the STS Congenital Heart Surgery Database and the STS General Thoracic Database every 6 months. In addition, given its belief in accountability, STS established a Public Reporting Task Force to coordinate voluntary public reporting initiatives using the Consumer Reports or STS websites.

The ultimate goal of all database activities is to improve patient outcomes, and specific quality improvement projects are developed and led by the STS Quality Initiatives Task Force. The STS Task Force on Longitudinal Follow-Up and Linked Registries coordinates the linkage of STS clinical registry data with complementary information regarding long-term outcomes and costs from other data sources. Additional STS National Database Task Forces include International Relations, Appropriateness, Cost and Resource Use, Dashboards, and Informatics.

In summary, the STS National Database is a uniquely valuable resource that is largely responsible for the dramatic improvements in cardiothoracic surgical outcomes that have occurred over the past quarter century.

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References

  • Carroll JD, Edwards FH, Marinac-Dabic D, et al. The STS-ACC transcatheter valve therapy national registry: a new partnership and infrastructure for the introduction and surveillance of medical devices and therapies. J Am Coll Cardiol. 2013;62(11):1026–34.

    Article  PubMed  Google Scholar 

  • Clark RE. It is time for a national cardiothoracic surgical data base. Ann Thorac Surg. 1989;48(6):755–6.

    Article  PubMed  CAS  Google Scholar 

  • Codman EA. The product of a hospital. Surg Gynecol Obstet. 1914;18:491–6.

    Google Scholar 

  • Codman EA. A study in hospital efficiency. As demonstrated by the case report of the first two years of a private hospital. Reprint edition (originally published privately 1914–1920) ed. Oakbrook Terrace: Joint Commission on Accreditation of Healthcare Organizations; 1995.

    Google Scholar 

  • Cronk CE, Malloy ME, Pelech AN, et al. Completeness of state administrative databases for surveillance of congenital heart disease. Birth Defects Res A Clin Mol Teratol. 2003;67(9):597–603.

    Article  PubMed  CAS  Google Scholar 

  • Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q. 1966;44(3):166–206.

    Article  Google Scholar 

  • Donabedian A. The quality of care. How can it be assessed? JAMA. 1988;260(12):1743–8.

    Article  PubMed  CAS  Google Scholar 

  • Donabedian A. The end results of health care: Ernest Codman’s contribution to quality assessment and beyond. Milbank Q. 1989;67(2):233–56.

    Article  PubMed  CAS  Google Scholar 

  • ElBardissi AW, Aranki SF, Sheng S, O’Brien SM, Greenberg CC, Gammie JS. Trends in isolated coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons adult cardiac surgery database. J Thorac Cardiovasc Surg. 2012;143(2):273–81.

    Article  PubMed  Google Scholar 

  • Ferguson Jr TB, Peterson ED, Coombs LP, et al. Use of continuous quality improvement to increase use of process measures in patients undergoing coronary artery bypass graft surgery: a randomized controlled trial. JAMA. 2003;290(1):49–56.

    Article  PubMed  Google Scholar 

  • Franklin RC, Jacobs JP, Krogmann ON, et al. Nomenclature for congenital and paediatric cardiac disease: historical perspectives and The International Pediatric and Congenital Cardiac Code. Cardiol Young. 2008;18 Suppl 2:70–80.

    Article  PubMed  Google Scholar 

  • Frobert O, Lagerqvist B, Olivecrona GK, et al. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med. 2013;369(17):1587–97.

    Article  PubMed  CAS  Google Scholar 

  • Frohnert BK, Lussky RC, Alms MA, Mendelsohn NJ, Symonik DM, Falken MC. Validity of hospital discharge data for identifying infants with cardiac defects. J Perinatol. 2005;25(11):737–42.

    Article  PubMed  Google Scholar 

  • Grover FL, Shahian DM, Clark RE, Edwards FH. The STS National Database. Ann Thorac Surg. 2014;97 Suppl 1:S48–54.

    Article  PubMed  Google Scholar 

  • Hammill BG, Hernandez AF, Peterson ED, Fonarow GC, Schulman KA, Curtis LH. Linking inpatient clinical registry data to Medicare claims data using indirect identifiers. Am Heart J. 2009;157(6):995–1000.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hannan EL, Cozzens K, King III SB, Walford G, Shah NR. The New York State cardiac registries: history, contributions, limitations, and lessons for future efforts to assess and publicly report healthcare outcomes. J Am Coll Cardiol. 2012;59(25):2309–16.

    Article  PubMed  Google Scholar 

  • Hibbard JH, Peters E, Slovic P, Finucane ML, Tusler M. Making health care quality reports easier to use. Jt Comm J Qual Improv. 2001;27(11):591–604.

    PubMed  CAS  Google Scholar 

  • Hillis LD, Smith PK, Anderson JL, et al. ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124(23):2610–42.

    Google Scholar 

  • Iezzoni LI. Risk adjustment for measuring health care outcomes. 3rd ed. Chicago: Health Administration Press; 2003.

    Google Scholar 

  • Jacobs JP, Jacobs ML, Mavroudis C, et al. Nomenclature and databases for the surgical treatment of congenital cardiac disease–an updated primer and an analysis of opportunities for improvement. Cardiol Young. 2008;18 Suppl 2:38–62.

    Article  PubMed  Google Scholar 

  • Jacobs JP, Jacobs ML, Lacour-Gayet FG, et al. Stratification of complexity improves the utility and accuracy of outcomes analysis in a multi-institutional congenital heart surgery database: application of the risk adjustment in congenital heart surgery (RACHS-1) and Aristotle systems in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database. Pediatr Cardiol. 2009;30(8):1117–30.

    Article  PubMed  Google Scholar 

  • Jacobs JP, Edwards FH, Shahian DM, et al. Successful linking of the Society of Thoracic Surgeons adult cardiac surgery database to Centers for Medicare and Medicaid Services Medicare data. Ann Thorac Surg. 2010;90(4):1150–6.

    Article  PubMed  Google Scholar 

  • Jacobs ML, Daniel M, Mavroudis C, et al. Report of the 2010 Society of Thoracic Surgeons congenital heart surgery practice and manpower survey. Ann Thorac Surg. 2011a;92(2):762–8.

    Article  PubMed  Google Scholar 

  • Jacobs JP, Edwards FH, Shahian DM, et al. Successful linking of the Society of Thoracic Surgeons database to social security data to examine survival after cardiac operations. Ann Thorac Surg. 2011b;92(1):32–7.

    Article  PubMed  Google Scholar 

  • Jacobs JP, Shahian DM, He X, et al. Penetration, completeness, and representativeness of the Society of Thoracic Surgeons adult cardiac surgery database. Ann Thorac Surg. 2016;101(1):33–41.

    Article  PubMed  Google Scholar 

  • Jantzen DW, He X, Jacobs JP, et al. The impact of differential case ascertainment in clinical registry versus administrative data on assessment of resource utilization in pediatric heart surgery. World J Pediatr Congenit Heart Surg. 2014;5(3):398–405.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kouchoukos NT, Ebert PA, Grover FL, Lindesmith GG. Report of the Ad Hoc Committee on risk factors for coronary artery bypass surgery. Ann Thorac Surg. 1988;45(3):348–9.

    Article  PubMed  CAS  Google Scholar 

  • Kozower BD, Sheng S, O’Brien SM, et al. STS database risk models: predictors of mortality and major morbidity for lung cancer resection. Ann Thorac Surg. 2010;90(3):875–81.

    Article  PubMed  Google Scholar 

  • Lauer MS, D’Agostino Sr RB. The randomized registry trial–the next disruptive technology in clinical research? N Engl J Med. 2013;369(17):1579–81.

    Article  PubMed  CAS  Google Scholar 

  • Mack MJ, Herbert M, Prince S, Dewey TM, Magee MJ, Edgerton JR. Does reporting of coronary artery bypass grafting from administrative databases accurately reflect actual clinical outcomes? J Thorac Cardiovasc Surg. 2005;129(6):1309–17.

    Article  PubMed  Google Scholar 

  • Mack MJ, Brennan JM, Brindis R, et al. Outcomes following transcatheter aortic valve replacement in the United States. JAMA. 2013;310(19):2069–77.

    Article  PubMed  CAS  Google Scholar 

  • Mallon WJ. Ernest Amory Codman: the end result of a life in medicine. Philadelphia: W.B.Saunders Company; 2000.

    Google Scholar 

  • Mavroudis C, Jacobs JP. Congenital heart surgery nomenclature and database project: overview and minimum dataset. Ann Thorac Surg. 2000;69(3, Suppl 1):S1–17.

    Article  Google Scholar 

  • Neuhauser D. Ernest Amory Codman, M.D., and end results of medical care. Int J Technol Assess Health Care. 1990;6(2):307–25.

    Article  PubMed  CAS  Google Scholar 

  • O’Brien SM, Shahian DM, Delong ER, et al. Quality measurement in adult cardiac surgery: part 2–Statistical considerations in composite measure scoring and provider rating. Ann Thorac Surg. 2007;83 Suppl 4:S13–26.

    Article  PubMed  Google Scholar 

  • O’Brien SM, Clarke DR, Jacobs JP, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg. 2009a;138(5):1139–53.

    Article  PubMed  Google Scholar 

  • O’Brien SM, Shahian DM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2–isolated valve surgery. Ann Thorac Surg. 2009b;88 Suppl 1:S23–42.

    Article  PubMed  Google Scholar 

  • O’Connor GT, Plume SK, Olmstead EM, et al. A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting. The Northern New England Cardiovascular Disease Study Group. JAMA. 1991;266(6):803–9.

    Article  PubMed  Google Scholar 

  • Overman DM, Jacobs JP, Prager RL, et al. Report from the Society of Thoracic Surgeons National Database Workforce: clarifying the definition of operative mortality. World J Pediatr Congenit Heart Surg. 2013;4(1):10–2.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pasquali SK, Jacobs JP, Shook GJ, et al. Linking clinical registry data with administrative data using indirect identifiers: implementation and validation in the congenital heart surgery population. Am Heart J. 2010;160(6):1099–104.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pasquali SK, Li JS, Jacobs ML, Shah SS, Jacobs JP. Opportunities and challenges in linking information across databases in pediatric cardiovascular medicine. Prog Pediatr Cardiol. 2012a;33(1):21–4.

    Article  Google Scholar 

  • Pasquali SK, He X, Jacobs JP, Jacobs ML, O’Brien SM, Gaynor JW. Evaluation of failure to rescue as a quality metric in pediatric heart surgery: an analysis of the STS Congenital Heart Surgery Database. Ann Thorac Surg. 2012b;94(2):573–9.

    Article  PubMed  Google Scholar 

  • Pasquali SK, Gaies MG, Jacobs JP, William GJ, Jacobs ML. Centre variation in cost and outcomes for congenital heart surgery. Cardiol Young. 2012c;22(6):796–9.

    Article  PubMed  Google Scholar 

  • Pasquali SK, Li JS, He X, et al. Perioperative methylprednisolone and outcome in neonates undergoing heart surgery. Pediatrics. 2012d;129(2):e385–91.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pasquali SK, Li JS, He X, et al. Comparative analysis of antifibrinolytic medications in pediatric heart surgery. J Thorac Cardiovasc Surg. 2012e;143(3):550–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Pasquali SK, Peterson ED, Jacobs JP, et al. Differential case ascertainment in clinical registry versus administrative data and impact on outcomes assessment for pediatric cardiac operations. Ann Thorac Surg. 2013;95(1):197–203.

    Article  PubMed  Google Scholar 

  • Passaro Jr E, Organ CH, Ernest Jr A. Codman: the improper Bostonian. Bull Am Coll Surg. 1999;84(1):16–22.

    PubMed  Google Scholar 

  • Patel MR, Dehmer GJ, Hirshfeld JW, et al. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography. J Thorac Cardiovasc Surg. 2012;143(4):780–803.

    Article  PubMed  Google Scholar 

  • Prager RL, Armenti FR, Bassett JS, et al. Cardiac surgeons and the quality movement: the Michigan experience. Semin Thorac Cardiovasc Surg. 2009;21(1):20–7.

    Article  PubMed  Google Scholar 

  • Shahian DM, Normand SL. Comparison of “risk-adjusted” hospital outcomes. Circulation. 2008;117(15):1955–63.

    Article  PubMed  Google Scholar 

  • Shahian DM, Edwards FH, Ferraris VA, et al. Quality measurement in adult cardiac surgery: part 1–Conceptual framework and measure selection. Ann Thorac Surg. 2007a;83 Suppl 4:S3–12.

    Article  PubMed  Google Scholar 

  • Shahian DM, Silverstein T, Lovett AF, Wolf RE, Normand SL. Comparison of clinical and administrative data sources for hospital coronary artery bypass graft surgery report cards. Circulation. 2007b;115(12):1518–27.

    Article  PubMed  Google Scholar 

  • Shahian DM, O’Brien SM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1–coronary artery bypass grafting surgery. Ann Thorac Surg. 2009a;88 Suppl 1:S2–22.

    Article  PubMed  Google Scholar 

  • Shahian DM, O’Brien SM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 3–valve plus coronary artery bypass grafting surgery. Ann Thorac Surg. 2009b;88 Suppl 1:S43–62.

    Article  PubMed  Google Scholar 

  • Shahian DM, Edwards FH, Jacobs JP, et al. Public reporting of cardiac surgery performance: part 1–history, rationale, consequences. Ann Thorac Surg. 2011a;92 Suppl 3:S2–11.

    Article  PubMed  Google Scholar 

  • Shahian DM, Edwards FH, Jacobs JP, et al. Public reporting of cardiac surgery performance: part 2–implementation. Ann Thorac Surg. 2011b;92 Suppl 3:S12–23.

    Article  PubMed  Google Scholar 

  • Shahian DM, He X, Jacobs JP, et al. The Society of Thoracic Surgeons isolated aortic valve replacement (AVR) composite score: a report of the STS Quality Measurement Task Force. Ann Thorac Surg. 2012a;94(6):2166–71.

    Article  PubMed  Google Scholar 

  • Shahian DM, O’Brien SM, Sheng S, et al. Predictors of long-term survival following coronary artery bypass grafting surgery: results from The Society of Thoracic Surgeons Adult Cardiac Surgery Database (The ASCERT Study). Circulation. 2012b;125(12):1491–500.

    Google Scholar 

  • Shahian DM, He X, Jacobs JP, et al. Issues in quality measurement: target population, risk adjustment, and ratings. Ann Thorac Surg. 2013a;96(2):718–26.

    Article  PubMed  Google Scholar 

  • Shahian DM, Jacobs JP, Edwards FH, et al. The Society of Thoracic Surgeons National Database. Heart. 2013b;99(20):1494–501.

    Article  PubMed  Google Scholar 

  • Shahian DM, He X, Jacobs JP, et al. The STS AVR + CABG composite score: a report of the STS Quality Measurement Task Force. Ann Thorac Surg. 2014;97(5):1604–9.

    Article  PubMed  Google Scholar 

  • Shahian DM, He X, Jacobs JP, et al. The Society of Thoracic Surgeons composite measure of individual surgeon performance for adult cardiac surgery: a report of the Society of Thoracic Surgeons quality measurement task force. Ann Thorac Surg. 2015;100:1315–1325.

    Article  PubMed  Google Scholar 

  • Shapiro M, Swanson SJ, Wright CD, et al. Predictors of major morbidity and mortality after pneumonectomy utilizing the Society for Thoracic Surgeons General Thoracic Surgery Database. Ann Thorac Surg. 2010;90(3):927–34.

    Article  PubMed  Google Scholar 

  • Speir AM, Rich JB, Crosby I, Fonner Jr E. Regional collaboration as a model for fostering accountability and transforming health care. Semin Thorac Cardiovasc Surg. 2009;21(1):12–9.

    Article  PubMed  Google Scholar 

  • Spiegelhalter DJ. Surgical audit: statistical lessons from Nightingale and Codman. J R Stat Soc (Series A). 1999;162(Part 1):45–58.

    Article  Google Scholar 

  • Strickland MJ, Riehle-Colarusso TJ, Jacobs JP, et al. The importance of nomenclature for congenital cardiac disease: implications for research and evaluation. Cardiol Young. 2008;18 Suppl 2:92–100.

    Article  PubMed  PubMed Central  Google Scholar 

  • STS long-term risk calculator. http://www.sts.org/quality-research-patient-safety/quality/ascert-long-term-survival-calculator. Accessed 11 July 2014.

  • STS National Database. http://www.sts.org/sections/stsnationaldatabase/. Accessed 26 July 2014.

  • STS Quality Improvement webinars. http://www.sts.org/education-meetings/sts-webinar-series. Accessed 12 July 2014.

  • STS Research Center. http://www.sts.org/sites/default/files/documents/pdf/DirectorSTSResearchCenter_April2014.pdf. Accessed 13 July 2014.

  • STS short term risk calculator. http://www.sts.org/quality-research-patient-safety/quality/risk-calculator-and-models. Accessed 11 July 2014.

  • Weintraub WS, Grau-Sepulveda MV, Weiss JM, et al. Comparative effectiveness of revascularization strategies. N Engl J Med. 2012;366(16):1467–76.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Wright CD, Kucharczuk JC, O’Brien SM, Grab JD, Allen MS. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg. 2009;137(3):587–95.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    David M. Shahian

  2. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MA, USA

    Jeffrey P. Jacobs

  3. Johns Hopkins All Children’s Heart Institute, Saint Petersburg/Tampa, FL, USA

    Jeffrey P. Jacobs

Authors
  1. David M. Shahian
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  2. Jeffrey P. Jacobs
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Corresponding author

Correspondence to David M. Shahian .

Editor information

Editors and Affiliations

  1. Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada

    Adrian Levy

  2. ICON plc, Vancouver, BC, Canada

    Sarah Goring

  3. Department of Biostatistics, Brown University, Providence, RI, USA

    Constantine Gatsonis

  4. University of British Columbia, Vancouver, BC, Canada

    Boris Sobolev

  5. European Observatory on Health Systems and Policies, Department of Health Care Management, Berlin University of Technology, Berlin, Germany

    Ewout van Ginneken

  6. Department Health Care Management Faculty of Economics and Management, Technische Universität Berlin, Berlin, Germany

    Reinhard Busse

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Shahian, D.M., Jacobs, J.P. (2019). Health Services Information: Lessons Learned from the Society of Thoracic Surgeons National Database. In: Levy, A., Goring, S., Gatsonis, C., Sobolev, B., van Ginneken, E., Busse, R. (eds) Health Services Evaluation. Health Services Research. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-8715-3_11

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