1 / 42

Does transparency improve quality? lessons learnt from cardiac surgery

This presentation explores whether increased transparency in cardiac surgery improves patient outcomes, drawing insights from the BCIS meeting in 2006. It reviews the historical context of cardiac surgical audits, highlighting data collection since 1977, as well as public accountability's effects on clinical practice. Key findings indicate that public reporting can lead to enhanced quality of care, albeit with potential risks of risk-averse behavior among surgeons, influencing case acceptance. The analysis includes mortality rates and trends, data from various registries, and implications for future practice.

odeda
Télécharger la présentation

Does transparency improve quality? lessons learnt from cardiac surgery

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Does transparency improve quality?lessons learnt from cardiac surgery BCIS meeting 2006 Ben Bridgewater SMUHT

  2. History of cardiac surgical audit • Cardiac surgery register since 1977

  3. History of cardiac surgical audit • Cardiac surgery register since 1977 • UK database since 1994

  4. History of cardiac surgical audit • Cardiac surgery register since 1977 • UK database since 1994 • Dr Foster/The Times 2001

  5. History of cardiac surgical audit • Cardiac surgery register since 1977 • UK database since 1994 • Dr Foster/The Times 2001 • Named unit mortality SCTS 2001

  6. History of cardiac surgical audit • Cardiac surgery register since 1997 • UK database since 1994 • Dr Foster/The Times 2001 • Named unit mortality SCTS 2001 • SCTS individual ‘standards’ 2003

  7. History of cardiac surgical audit • Cardiac surgery register since 1997 • UK database since 1994 • Dr Foster/The Times 2001 • Named unit mortality SCTS 2001 • SCTS individual ‘standards’ 2003 • Guardian named surgeon data 2005 • Freedom of Information Act

  8. History of cardiac surgical audit • Cardiac surgery register since 1977 • UK database since 1994 • Dr Foster/The Times 2001 • Named unit mortality SCTS 2001 • SCTS individual ‘standards’ 2003 • Guardian named surgeon data 2005 • Healthcare commission named surgeon data 2006

  9. History of cardiac surgical audit • Cardiac surgery register since 1997 • UK database since 1994 • Dr Foster/The Times 2001 • Named unit mortality SCTS 2001 • SCTS individual ‘standards’ 2004 • Guardian named surgeon data 2005 • Healthcare commission named surgeon data 2006

  10. History of cardiac surgical audit • Cardiac surgery register since 1997 • UK database since 1994 • Dr Foster/The Times 2001 • Named unit mortality SCTS 2001 • SCTS individual ‘standards’ 2004 • Guardian named surgeon data 2005 • Healthcare commission named surgeon data 2006

  11. History of cardiac surgical audit • Cardiac surgery register since 1997 • UK database since 1994 • Dr Foster/The Times 2001 • Named unit mortality SCTS 2001 • SCTS individual ‘standards’ 2004 • Guardian named surgeon data 2005 • Healthcare commission named surgeon data 2006

  12. History of cardiac surgical audit • Cardiac surgery register since 1997 • UK database since 1994 • Dr Foster/The Times 2001 • Named unit mortality SCTS 2001 • SCTS individual ‘standards’ 2004 • Guardian named surgeon data 2005 • Healthcare commission named surgeon data 2006

  13. Issues • Has public accountability improved quality?

  14. Issues • Has public accountability improved quality? • Is there now a culture of ‘risk-averse’ behaviour?

  15. Has public accountability improved quality?

  16. Has public accountability improved quality? Mortality significantly higher than average – Dr Foster Mortality significantly lower than average – Healthcare commission

  17. Risk adjusted mortality – National data – isolated CABG Increased predicted risk Decreased observed mortality

  18. Hawthorn effect Public disclosure • New York state database • Pennsylvania report cards • SCTS database • Northern New England Cardiovascular study group • VA database • NW regional audit project 1997 to 2001 No disclosure

  19. Collecting and using data improves the quality of outcomes

  20. Why is public reporting important? Because it has driven data collection and use Clinicians managers support staff professional organisations

  21. Is there now a culture of risk averse behaviour?

  22. Is there now a culture of risk averse behaviour? • Newsnight survey of UK cardiac surgeons 2000 • 80% surgeons in favour of public accountability • 90% felt that high risk cases would be turned down • Only 6% felt that available algorithms adjusted appropriately for risk See also Burack 1999, Schneider and Epstein 1996, Narins 2005

  23. Existing data • Little ‘hard’ statistical data investigating the influence of public accountability on cardiac surgical practice • NY experience suggests conflicting data • Hannan 1996 • Dranove 2003

  24. Is there risk averse behaviour in the UK? • Very difficult to measure surgical ‘turndowns’ • If there was significant risk averse behaviour you would expect to see a decrease in the number of high risk cases coming to surgery • Complex issues with respect to surgical case mix due to PCI developments

  25. Northwest data 1997 to 2005 • 25,730 patients under 30 surgeons • Isolated CABG alone • Observed and predicted mortality • Number of low risk, high risk and very high patients each year • 2 time periods • 1997 to 2001 – prior to public disclosure • 2001 to 2005 – post public disclosure

  26. Results • Significant decrease in observed mortality • Significant increase in overall predicted mortality • Significant decrease in risk adjusted mortality

  27. Results • Significant decrease in observed mortality • Significant increase in overall predicted mortality • Significant decrease in risk adjusted mortality

  28. Is there now a culture of risk averse behaviour? • No overall effect • May be transient or individual effects • Important that this is ‘mopped up’

  29. Is there now a culture of risk averse behaviour? • What is perceived by someone as risk-averse behaviour is perceived by another as good clinical decision making

  30. Is there now a culture of risk averse behaviour? • What is perceived by someone as risk-averse behaviour is perceived by another as good clinical decision making • Transparency may have focussed the multidisciplinary team on optimising treatment strategies for individual patients

  31. Risk adjustment • ‘No model is perfect – some are useful’

  32. Risk adjustment • ‘No model is perfect – some are useful’ • Need clarity around ‘fit for purpose’

  33. Risk adjustment • ‘No model is perfect – some are useful’ • Need clarity around ‘fit for purpose’ • Arguments about models can paralyse developments

  34. Risk adjustment • ‘No model is perfect – some are useful’ • Need clarity around ‘fit for purpose’ • Arguments about models can paralyse developments • Model ‘drift’ • Calibration and weightings

  35. Risk adjustment • ‘No model is perfect – some are useful’ • Need clarity around ‘fit for purpose’ • Arguments about models can paralyse developments • Model ‘drift’ • Calibration and weightings • Progress will be too slow for some and too quick for others

  36. Good Luck!

More Related