Has the publication of cardiac surgery outcome data been associated with changes in practice in northwest England: an analysis of 25 730 patients undergoing CABG surgery under 30 surgeons over eight years

Bridgewater, Ben; Grayson, Antony D.; Brooks, N; Grotte, Geir J.; Fabri, Brian M.; Au, John; Hooper, Timothy L.; Jones, Mark T.; Keogh, Bruce

doi:10.1136/hrt.2006.106393

Cited by 127 publications

(100 citation statements)

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“…Of these, 15 died on the day of admission or the day after admission (1.3%), 34 died within seven days (3.1%) and 65 patients had died within 30 days (6.3%). The median SCS was five (interquartile range (IQR) [3][4][5][6][7][8]. The median length of stay was four days (IQR 1-11 days).…”

Section: Resultsmentioning

confidence: 99%

“…5 Comparison of mortality in cardiothoracic centres has led to improvements in the standard of care. 6,7 Earlier research showed how a simple scoring model, the Modified Early Warning Score (MEWS), was used to gauge the risk of patients for catastrophic deterioration. 8 However, the proposed model lacked specificity to evaluate the risk of in-hospital death for individual patients.…”

Section: Introductionmentioning

confidence: 99%

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The Simple Clinical Score: a tool for benchmarking of emergency admissions in acute internal medicine

Jishi

Hibbs

2010

Clinical Medicine

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-Quality of care in intensive care and surgery has benefited from establishing comparative standards. At present there is no accepted tool to compare outcomes for emergency admissions in internal medicine. The Simple Clinical Score (SCS) was used in 1,098 consecutive medical emergency admissions to adjust mortality for severity of illness. Hospital mortality adjusted for severity of illness and length of stay in the cohort was in keeping with mortality in the Irish derivation study with a trend towards lower mortality in the very high-risk group. Three parameters with poor reproducibility were identified. The SCS has several potential applications: identification of patients with low risk of death suitable for early hospital discharge; early identification of patients with a high risk of death, who will require care in critical care areas (or specialist palliative care); and benchmarking of acute medical departments internationally in a similar way to how APACHE II scoring has been used in critical care units worldwide. 1

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Simple Clinical Score: a tool for benchmarking of emergency admissions in acute internal medicine

Jishi

Hibbs

2010

Clinical Medicine

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“…19,[26][27][28] In general, these reviews found a small decline in mortality following public reporting after controlling for trends in a reduction of mortality; however, individual studies varied in their findings. For example, studies examining the impact of cardiac public reporting programmes on mortality rates found a variable picture: eight studies found a decrease in mortality rates over time, [29][30][31][32][33][34][35][36] while another four studies [37][38][39][40] found no changes in mortality rates over time. Similarly, although most studies examining the impact of public reporting on process indicators found an improvement in hospital quality, this varied from a 'slight' improvement to a 'significant' improvement.…”

Section: Existing Evidencementioning

confidence: 99%

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

175

263

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BackgroundThe feedback of patient-reported outcome measures (PROMs) data is intended to support the care of individual patients and to act as a quality improvement (QI) strategy.ObjectivesTo (1) identify the ideas and assumptions underlying how individual and aggregated PROMs data are intended to improve patient care, and (2) review the evidence to examine the circumstances in which and processes through which PROMs feedback improves patient care.DesignTwo separate but related realist syntheses: (1) feedback of aggregate PROMs and performance data to improve patient care, and (2) feedback of individual PROMs data to improve patient care.InterventionsAggregate – feedback and public reporting of PROMs, patient experience data and performance data to hospital providers and primary care organisations. Individual – feedback of PROMs in oncology, palliative care and the care of people with mental health problems in primary and secondary care settings.Main outcome measuresAggregate – providers’ responses, attitudes and experiences of using PROMs and performance data to improve patient care. Individual – providers’ and patients’ experiences of using PROMs data to raise issues with clinicians, change clinicians’ communication practices, change patient management and improve patient well-being.Data sourcesSearches of electronic databases and forwards and backwards citation tracking.Review methodsRealist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care.ResultsProviders were more likely to take steps to improve patient care in response to the feedback and public reporting of aggregate PROMs and performance data if they perceived that these data were credible, were aimed at improving patient care, and were timely and provided a clear indication of the source of the problem. However, implementing substantial and sustainable improvement to patient care required system-wide approaches. In the care of individual patients, PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians’ communication practices with patients. Patients valued both standardised and individualised PROMs as a tool to raise issues, but thought is required as to which patients may benefit and which may not. In settings such as palliative care and psychotherapy, clinicians viewed individualised PROMs as useful to build rapport and support the therapeutic process. PROMs feedback did not substantially shift clinicians’ communication practices or focus discussion on psychosocial issues; this required a shift in clinicians’ perceptions of their remit.Strengths and limitationsThere was a paucity of research examining the feedback of aggregate PROMs data to providers, and we drew on evidence from interventions with similar programme theories (other forms of performance data) to test our theories.ConclusionsPROMs data act as ‘tin openers’ rather than ‘dials’. Providers need more support and guidance on how to collect their own internal data, how to rule out alternative explanations for their outlier status and how to explore the possible causes of their outlier status. There is also tension between PROMs as a QI strategy versus their use in the care of individual patients; PROMs that clinicians find useful in assessing patients, such as individualised measures, are not useful as indicators of service quality.Future workFuture research should (1) explore how differently performing providers have responded to aggregate PROMs feedback, and how organisations have collected PROMs data both for individual patient care and to improve service quality; and (2) explore whether or not and how incorporating PROMs into patients’ electronic records allows multiple different clinicians to receive PROMs feedback, discuss it with patients and act on the data to improve patient care.Study registrationThis study is registered as PROSPERO CRD42013005938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…We need to understand better the size and nature of the problem nationally and how we compare internationally, to have high quality risk-adjusted outcome data to support decision making, and to counsel patients and their families. This approach has been used with success to drive improvement in cardiac surgery [21]. The need for more outcome data is the basis on which the emergency laparotomy network has been founded [22] and for the forthcoming European Surgical Outcomes Study (EuSoS).…”

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confidence: 99%

Emergency surgery in the elderly patient: a quality improvement approach

Peden¹

2011

Anaesthesia

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Has the publication of cardiac surgery outcome data been associated with changes in practice in northwest England: an analysis of 25 730 patients undergoing CABG surgery under 30 surgeons over eight years

Abstract: Publication of cardiac surgery mortality data in the UK has been associated with decreased risk adjusted mortality on retrospective analysis of a large patient database. There is no evidence that fewer high risk patients are undergoing surgery because mortality rates are published.

Cited by 127 publications

References 20 publications

The Simple Clinical Score: a tool for benchmarking of emergency admissions in acute internal medicine

The Simple Clinical Score: a tool for benchmarking of emergency admissions in acute internal medicine

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Emergency surgery in the elderly patient: a quality improvement approach

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