A Dashboard for Tracking Mortality After Cardiac Surgery Using a National Administrative Database

Abstract

Background Mortality after cardiac surgery is publicly reportable and used as a quality metric by national organizations. However, detailed institutional comparisons are often limited in publicly reported ratings, while publicly reported mortality data are generally limited to 30-day outcomes. Dashboards represent a useful method for aggregating data to identify areas for quality improvement. Methods We present the development of a dashboard of cardiac surgery performance using cardiac surgery admissions in a national administrative dataset, allowing institutions to better analyze their clinical outcomes. We identified cardiac surgery admissions in the Medicare Limited Data Sets from April 2016 to March 2017 using diagnosis-related group (DRG) codes for cardiac valve and coronary bypass surgeries. Results Using these data, we created a dashboard prototype to enable hospitals to compare their individual performance against state and national benchmarks, by all cardiac surgeries, specific cardiac surgery DRGs and by specific surgeons. Mortality rates are provided at 30, 60 and 90 days post-operatively as well as 1 year. Users can filter results by state, hospital and surgeon, and visualize summary data comparing these filtered results to national metrics. Examples of using the dashboard to examine hospital and individual surgeon mortality are provided. Conclusions We demonstrate how this database can be used to compare data between comparator hospitals on local, state and national levels to identify trends in mortality and areas for quality improvement.

Addressing the National Crisis Facing Black and Latina Women, Birthing People, and Infants: The Maternal and Child Health Equity Summit

“…Consistent data collection of risk-adjusted outcomes by race should be established as a norm at hospitals, with disparities in outcomes noted and publicly available, similar to cardiac outcome data. 12 Specific recommendations from summit participants included the following:…”

Development and implementation of databases to track patient and safety outcomes

“…A more practical approach that can be utilized in near real-time is by creating dashboards and other visualization tools that can allow hospitals to better track outcomes and compare performance in relation to state and national benchmarks. Using a large administrative database, a dashboard was created based on identifying cardiac surgery admissions using a large national administrative dataset, and mortality rates are provided at 30, 60, 90 days, and 1 year postoperatively [38]. Users can filter results by state, hospital, and individual provider and visualize summary data comparing these filtered results to national metrics.…”

Developing the VA Geriatric Scholars Programs' Clinical Dashboards Using the PDSA Framework for Quality Improvement

“…These studies report on dashboard performance as measured by end user uptake, usability, or associated improvement in health outcomes, with some detail provided on which factors in their development process were believed to contribute to the dashboard's successes. 7 8 9 10 11 12 There is growing consensus that involving clinicians in the development process of audit and feedback clinical dashboards is important to ensure that user needs are adequately met prior to releasing the dashboard for routine use, subsequently improving uptake and adoption. 13 14 This principle has long been understood in the field of human-centered design, which seeks to systematically integrate end-user feedback throughout the development process.…”