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IHY 99-214 – HSR&D Study

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IHY 99-214
QUERI - Proposal to Expand Data Collection and Reports to Evaluate VA Cardiac Surgery Program Performance
Annie Laurie Shroyer PhD MHSA
Rocky Mountain Regional VA Medical Center, Aurora, CO
Aurora, CO
Funding Period: January 1999 - December 2000

BACKGROUND/RATIONALE:
Since 1987, the Continuous Improvement in Cardiac Surgery Program (CICSP) has produced risk-adjusted mortality and morbidity reports for cardiac surgery teams and VA Cardiac Surgery Consultants Committee (CSCC) for continuous quality improvement purposes.

OBJECTIVE(S):
The objectives for this expansion project were threefold: 1) to broaden the range of outcomes measured; 2) to evaluate new process and structure of care information; and 3) to add new resource utilization measures into the historical semi-annual CICSP reports produced.

METHODS:
The CICSP-X (a prospective, observational study) was completed by identifying new opportunities to improve the quality and cost-effectiveness of care rendered to VA patients undergoing coronary artery bypass graft (CABG-only) procedures. By linking to other VA secondary databases, the original CICSP reporting functions were augmented to include new patient self-report survey data, medication use guideline concordance, longer-term survival and resource use indicators.

FINDINGS/RESULTS:
New geographic distribution maps related to veterans served have been developed. New processes of care reports have been established to monitor the use of off-pump techniques, minimally invasive incision techniques, cardiopulmonary bypass time, ischemic time, and types of grafts used in coronary artery bypass procedures. New resource utilization reports include tracking the total length of stay (LOS), the preoperative LOS, and the postoperative LOS, the proportion of elective cases with same day surgery admission, the proportion of patients with a catheterization performed in the same admission as surgery, and the LOS in the intensive care unit. New patient-based outcome reports of satisfaction and health-related quality of life have been developed. New medication use rate and risk-adjusted 180-day survival reports have been approved and disseminated. A key aspect of this project is that appropriate collaborations have been forged to expand the CICSP data capture and to obtain access to other secondary databases to link to the primary CICSP data captured. Using these data extracts, enhanced CICSP-X reports have been developed, reviewed, revised, and approved. These expanded reports will continue to be incorporated into the semi-annual VA center and VISN distributions.

IMPACT:
The new CICSP-X reports have been viewed as very valuable information by both providers and administrators faced with developing and implementing quality improvement initiatives.

PUBLICATIONS:

Journal Articles

  1. Plomondon ME, Casebeer AW, Schooley LM, Wagner BD, Grunwald GK, McDonald GO, Grover FL, Shroyer AL. Exploring the volume-outcome relationship for off-pump coronary artery bypass graft procedures. The Annals of thoracic surgery. 2006 Feb 1; 81(2):547-53.
  2. Gibney EM, Casebeer AW, Schooley LM, Cunningham F, Grover FL, Bell MR, McDonald GO, Shroyer AL, Parikh CR. Cardiovascular medication use after coronary bypass surgery in patients with renal dysfunction: a national Veterans Administration study. Kidney international. 2005 Aug 1; 68(2):826-32.


DRA: Health Systems
DRE: Technology Development and Assessment
Keywords: Cardiac procedures, Ischemic Heart Disease, Quality assessment
MeSH Terms: none

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