For decades, cardiac surgeons have been considered leaders in the field of periprocedural data collection. The development of robust, observational data registires such as the Society of Thoracic Surgeons (STS) National Database in 1989 allowed for the reporting of risk-adjusted cardiac surgical outcomes across the United States and beyond. This process has seen the creation of national benchmarks, quality indicators, quality improvement initiatives and public report cards.
In Canada, despite the presence of a single-payer, universal-access healthcare system, significant heterogeneity exists in the collection of cardiac surgical data. Furthermore, there is no consistent mandatory requirement for collecting or validating data registries. An environmenral scan across the country reveals a variety of clinical or observational registries with few inter-provincial data linkages and little consistency in variable selection and data definitions.
In 2013, the Canadian Cardiovascular Society (CCS) Cardiac Surgery Quality Indicator Working Group selected five cardiac surgery quality indicators – 30-day mortality rates following isolated CABG, 30-day mortality rates following isolated AVR, 30-day mortality rates following combined CABG/AVR, 30-day rates of readmission following isolated CABG, and 365-day rates of cardiac readmission following isolated CABG. In order to operationalize these quality indicators, the CCS partnered with the Canadian Institute for Health Information (CIHI) to produce the Cardiac Care Quality Indicator (CCQI) report, a report which publicly disseminates crude and risk-adjusted rates of the aforementioned quality indictors by centre and over time.
Since its inception, the CCQI report and similar public report cards have been met with mixed reviews. In spite of the tremendous efforts that have been made to ensure the accuracy and scientific rigour of these reports, doubts regarding the accuracy and validity of administrative data and its risk-adjustment models and concerns regarding the approrpriateness of public report cards in Canada remain.
This workshop will gather national academic thought and clinical care leaders to discuss four major issues facing the public reporting of cardiac surgical oucomes in Canada in an interactive mini debate format:
1. The advantages and disadvantages of observational data registries vs. administrative data registries
2. The validity of risk-adjustment models in accounting for differences in patient populations
3. The perceived impact of public report cards on cardiac surgical outcomes
4. The need for public reporting of cardiac surgical outcomes in Canada