A roster of national consensus measures for evaluating and reporting heart surgery quality in hospitals, endorsed by the National Quality Forum, set the stage for consumers to be told about death rates in six categories of cardiac procedures and about rates for several types of major complications.
Other measures monitor the timing, selection and duration of antibiotics used in the course of infection prevention during and after surgery, and they also keep track of whether certain medications are prescribed at discharge.
The 21 measures add to the compendium of measures that the Washington-based consensus-building organization has pumped out in the past two years. The organization endorsed 15 measures for evaluating the impact of nursing care on healthcare operations in January. In 2003 it issued endorsements for 30 safe healthcare practices and an initial set of 39 hospital performance measures. A set of 28 proposed home-care measures was issued for public comment earlier this month.
Though the endorsements alone have no mandate in the healthcare industry, quality oversight and government healthcare regulatory organizations have adopted NQF measures in their reporting initiatives.
The cardiac surgery measures include death rates for coronary artery bypass surgery-a standard for years-but for the first time it's joined by risk-adjusted measures of mortality for two types of heart valve replacements as well as separate measures for when those procedures are combined with coronary artery bypass surgery. The Society of Thoracic Surgeons, which operates a database with 3 million cases, developed a risk-adjustment model for those procedures in just the past few years, said Jeffrey Rich, a member of the society board and co-chairman of the NQF steering committee that came up with the 21 measures.
Also included were two measures of overall mortality for bypass surgery: deaths in the hospital and deaths in the operating room.
The thoracic surgery group had initially campaigned for a measure of mortality 30 days after the procedure instead of limiting it to the length of a hospital stay. Rich said the 30-day span was "more scientifically sound" and would yield higher death rates-complicated problems that start in the hospital often have fatal consequences after discharge, for example.
But one component of NQF consensus in creating measures is the ability to track the necessary data at a reasonable cost, and proponents of the 30-day standard "acquiesced to some people who are having data-collection issues," Rich said.