Sunnybrook and Women's College Health Sciences Centres

November 04, 2005 08:59 ET

Quality of care measurements to increase accountability in cardiac s

Regulating Health Care in Canada Beyond Wait Times Attention: Health/Medical Editor TORONTO/ONTARIO--(CCNMatthews - Nov. 4, 2005) - A new list of quality control measurements has been developed to encourage cardiac surgeons to voluntarily report processes and patient outcomes. The measurements will monitor, standardize and improve performance and quality of care provided in Canadian hospitals.

Although wait times for cardiac surgical procedures have improved with monitoring, the quality of care delivered by cardiac surgical services still varies by hospital. Currently there are no mandatory regulations in Canada on the measuring or reporting of care and outcomes in cardiac surgery, other than reports that are mortality focused. Researchers at Sunnybrook & Women's suggest the traditional mortality-focused reports may deliver the wrong message to the public about the performance of a hospital, as there is weak evidence to link mortality to quality of care.

"There are many other measurable factors of quality of care that can affect the care received by patients in cardiac surgery and we need to have a standard and more comprehensive way for public reporting," says Dr. Veena Guru, cardiovascular surgery fellow and epidemiologist at Sunnybrook and Women's College Health Sciences Centre, and lead investigator of a new study to develop the new quality control indicators. "Cardiac surgery is a high-risk specialty and we are obligated to patients to report our performance and should aim to standardize processes, particularly in a public health system where accountability is crucial."

The list, consisting of a number of measurable standards of care, is intended to encourage cardiac surgery practitioners to voluntarily report information about their coronary artery bypass graft surgery cases, also commonly known as bypass surgery. Chosen by consensus by a panel of various specialists throughout North America, the list is comprised of a total of 18 variables:

· 14 are outcome variables: defined as significant adverse events that patients can experience after bypass surgery, resulting in unintended death or disability of which a proportion are caused by healthcare management rather than a patient's underlying disease state.
· three are process of care variables: which include those medical or surgical practices that current professional knowledge indicates are beneficial to patients in minimizing adverse clinical outcomes; these variables should be utilized whenever appropriate (i.e. prescribing medications, performing specific surgical procedures, specific training techniques);
· structure variable: defined as those variables related to the organizational level of an institution that may correlate to outcomes (the way in which the structure of a hospital is set up for care and is highly dependent on funding from government; i.e. nurse to patient ratios, number of physicians in Emergency, wait times and surgery volumes a year).

Not all measurements are included in the list for public reporting as they may have been deemed too difficult to translate to the public without risk of misinforming. Therefore practitioners are encouraged to report and assess additional items internally.

The study authors are hopeful that practitioners will begin by measuring internally and eventually move on to public reporting across Canada, in an effort to align their care with current best available evidence; improving performance and care in the system as a whole. "It's up to individual hospitals and cardiac surgery departments right now to voluntarily report or provide data on their quality indicator rates," says Dr. Guru. "Currently in Ontario some of this information is already available through existing administrative and clinical databases, but eventually each hospital will require a database to comprehensively track quality of care through the recommended indicators."

There are some accepted and common practices in cardiac surgery that are believed to be beneficial to patients and these need to be monitored and applied equally. Everything from transfusion rates, length of stay, and prescription of medicines can vary quite a bit across hospitals. "There are general standards we should all be aiming to adhere to on an ongoing basis," says Dr. Guru. "There is always a risk to care, but our goal is to try to minimize risks as much as possible by employing the most appropriate practices. There are always factors that can't be controlled for but we must strive to minimize adverse outcomes experienced by patients as much as we can by monitoring quality. This is just a start and then we hope to add to the list as we understand which practices most benefit improved outcomes for patients."

In Ontario, many cardiac surgery practitioners have led the way by voluntarily publicly reporting their hospital specific performance with respect to mortality and hospital length of stay since 1999. Other provinces have begun reporting internally more recently. However, there have been no hospital specific public report cards in other provinces. There are 11 hospitals in Ontario currently providing cardiac surgery.

The study "The identification and development of Canadian coronary artery bypass graft surgery quality indicators" is published in the November 2005 issue of the Journal of Thoracic and Cardiovascular Surgery. Funded by the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada, and the Tanna Schulich scholarship, this study was completed at Sunnybrook and Women's College Health Sciences Centre, with support from the Institute for Clinical Evaluative Sciences. Further information about this research group's quality improvement projects can be accessed at

Schulich Heart Centre at Sunnybrook and Women's College Health Sciences Centre is one of Canada's leading cardiac care centres with an international reputation as a leading-edge provider for the prevention, treatment and care of heart disease. Schulich Heart Centre delivers a full spectrum of in-hospital and ambulatory cardiovascular care, significantly improving the quality of life for patients with heart conditions in Canada.
/For further information: IN: HEALTH

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