Foundation’s TQI publishes report on “Operative Mortality”

A new report by the DFW Hospital Council (DFWHC) Foundation’s Texas Quality Initiative found an excessive number of unknown statuses for patients following coronary artery bypass surgery. Titled “Impact of Accurate 30-Day Status on Operative Mortality: Wanted Dead or Alive, Not Unknown” and published this month in The Annals of Thoracic Surgery, the official journal of the Society of Thoracic Surgeons, the study is now available online.

The Texas Quality Initiative (TQI) was created in 2012 with a mission to improve the quality and safety of care for cardiovascular surgery patients. The group is led by cardiothoracic surgeons affiliated with Baylor Scott & White Health, Medical City Healthcare, Methodist Health System, Texas Health Resources and UT Southwestern and administered through the DFWHC Foundation.

Coordinated by Dr. W. Steves Ring of UT Southwestern, colleagues examined if the use of administrative data in conjunction with clinical data would improve the accuracy of knowing a patient’s mortality within 30-days after having cardiac surgery. The findings revealed improved accuracy of clinical data could be achieved to reveal patient outcomes.

“The results were of great importance to not just the Dallas-Fort Worth region, but any market where data is used to improve patient care,” said Dr. Judy Bezanson, director of performance improvement and TQI at the DFWHC Foundation. “The DFWHC Foundation’s ability to match TQI data with administrative claims data from its own data warehouse provides a more accurate assessment of a patient’s recovery.”

The study found 22 percent of the coronary artery bypass patients had an “unknown” 30-day status following surgery, making it difficult to accurately determine mortality rates. Matching the TQI data to administrative claims data reduced the unknowns to only seven percent.

Prior to matching the clinical and administrative data, the Society of Thoracic Surgeons (STS) method assumed “unknown” statuses to be designated “alive,” improving the mortality rate to 27 percent higher than reality. In addition, the overall exclusion of unknowns overestimated the mortality rate by 30 percent higher than reality.

“The current STS system of entering unknown 30-day statuses as alive and a strategy of excluding cases with unknown 30-day statuses both resulted in calculation errors for mortality rates,” Dr. Bezanson said. “External validation by matching with administrative databases can greatly improve the accuracy of clinical databases such as those for STS Adult Cardiac Surgery.”

The goal of TQI is to merge clinical data with administrative data to provide overall transparency and improved accuracy when determining patient outcomes. TQI members have combined all STS Registry information from each participating hospital system into a single database. This permits TQI to compare results and evaluate performance within the region as well as nationally. The initiative shares such crucial information to allow both hospital leaders and surgeons alike to make more accurate decisions when utilizing resources and identifying where improvement is needed.

You can read the full study here. For information, please contact Dr. Bezanson at jbezanson@dfwhcfoundation.org or 469-648-5032.