Recognizing reliable clinical data is vital as public reporting increases

For heart and lung surgery, The Society of Thoracic Surgeons (STS) continues to set the gold standard through its world-renowned STS National Database and public reporting initiatives. Participants in the Database can volunteer to publicly report outcomes for surgical procedures, including coronary artery bypass grafting (CABG) surgery, aortic valve replacement (AVR), and CABG combined with AVR. A similar initiative has just begun in congenital heart surgery, and general thoracic ratings will be available next year.

"STS believes the public has a right to know the quality of surgical outcomes and considers public reporting to be an ethical responsibility of our specialty," said David M. Shahian, MD, Chair of the STS Council on Quality, Research, and Patient Safety and Vice President of the Massachusetts General Hospital Center for Quality and Safety. "STS public reporting uses a measurement system that was developed by surgeons, in conjunction with statisticians; all our measures are completely transparent and published in peer-reviewed journals. Most of our commonly used measures also are endorsed by the National Quality Forum, which is the most rigorous national vetting process for performance measures. We are very proud to have the largest number of NQF-endorsed measures of any professional society."

U.S. News Recognizes Value of STS Data

The new "Best Hospitals for Common Care" ratings released May 20 by U.S. News & World Report highlight the importance of public reporting. One of the quality measures in the U.S. News methodology rewards hospitals that participate in STS Public Reporting Online for CABG, AVR, and CABG+AVR.

"Patients deserve access to the best possible information when researching where to go for treatment, and they are increasingly looking to public reporting websites, including U.S. News, because they know that's where they'll find authoritative data," said Ben Harder, Chief of Health Analysis at U.S. News & World Report. "Transparency initiatives, such as STS public reporting, help reporters and news outlets provide better information to patients, enabling them to make more well-informed decisions on where to look for treatment."

To provide hospitals credit for public reporting participation, U.S. News reviewed the information available on STS Public Reporting Online at www.sts.org/publicreporting.

Sifting Through the Data

"While there are other health care 'report cards' publicly available to patients, many are based solely on billing and administrative data and use methodologies that are not transparent to the public," explained Dr. Shahian. "STS public reporting uses detailed clinical registry data and outcomes that have been risk adjusted, meaning that the results take into account the condition of the patient at the time of surgery and whether or not there were other health problems, such as diabetes."

A more complete explanation of risk-adjusted data is available on the STS website. "We are completely transparent about how we measure hospital performance, which assures patients that our data are accurate and reliable," said Dr. Shahian.

Making it easier for patients to understand the results for individual STS Database participants (which are generally hospitals, but may be practice groups), STS uses a star ratings system to indicate performance. Participants receive a 3-star, 2-star, or 1-star rating. "Three-star programs perform better than average, an STS rating that is very difficult to achieve. Patients should understand that an STS 2-star program, is also performing well; three quarters of the programs in the country fall into this category," said Dr. Shahian. "Our star ratings provide a guide, but do not always indicate a hospital's exact performance. A patient should use the star rating as a way to open discussion with his or her surgeon about the recommended procedure and expected outcomes."

STS Public Reporting Online was launched in late 2010. Overall composite star ratings, as well as component ratings, are listed for more than 400 STS National Database participants. The next round of public reporting results will be available on the website later this summer.