November 29, 2006
NEW YORK STATE CARDIAC SURGERY REPORTING AND QUALITY IMPROVEMENT SYSTEM
By: John Kasprak, Senior Attorney
You asked for information on a New York program that reports on the outcomes of cardiac surgery and other heart-related treatments.
NEW YORK STATE CARDIAC SURGERY PROGRAM
Since 1989, the New York Department of Health (DOH) has published annual data on risk-adjusted mortality following coronary artery bypass surgery by hospital and surgeon. The state's Cardiac Surgery Reporting System (CSRS) was the first program in the country to produce public data on outcomes for cardiac surgery and is the nation's longest running program of its kind.
DOH is advised in its activities by the Cardiac Advisory Committee (CAC), a group of independent, practicing cardiac surgeons, cardiologists and other professionals in related fields.
The goal of DOH and the CAC is to improve the quality of care related to cardiac surgery in the state. Providing hospitals and cardiac surgeons in New York with data about their own outcomes for these procedures allows them to examine the quality of care they provide and to identify areas needing improvement.
The program operates under the general authority of the DOH commissioner.
Analysis and Use of Data; Quality Improvement
The CSRS results have been used to create a cardiac profile system that assesses the performance of hospitals and surgeons over time, independent of the severity of individuals' pre-operative conditions. The program is aimed at:
1. understanding the health risks of patients that adversely affect how they will fare in coronary artery bypass surgery and valve surgery,
2. improving the results of different heart disease treatments,
3. improving cardiac care, and
4. providing information to help patients make better decisions about their own care.
CAC reviews the data collected and analyzed. Committee members assist with interpretation and advise DOH regarding hospitals and surgeons that may need special attention. The CAC has also visited particular hospitals and has recommended that some facilities use outside consultants to design improvements for their programs.
DOH states that “the overall results of the program of ongoing review show that significant progress is being made. In response to the program's results for surgery, facilities have refined patient criteria, evaluated patients more closely for pre-operative risks and directed them to the appropriate surgeon. More importantly, many hospitals have identified medical care process problems that have led to less than optimal outcomes, and have altered those processes to achieve improved results” (Adult Cardiac Surgery in New York State 2002-2004, New York Department of Health, June 2006; attached).
The annual data on cardiac surgery and care is available to the public. Its annual “Adult Cardiac Surgery” report, according to DOH, is intended for health care providers, patients, and families of patients who are considering cardiac surgery. It provides data on risk factors associated with death following coronary artery bypass and heart valve surgery. The report also lists hospital and physician-specific mortality rates which have been risk-adjusted to account for differences in patient severity of illness. DOH encourages physicians to discuss the information in the report with their patients and colleagues as they develop treatment plans.
Two articles from the health policy journal Health Affairs examining the New York program are attached.