EditorialHospital Performance Assessment in Congenital Heart Surgery: Where Do We Go From Here?
Section snippets
Current State—Congenital Heart Care Delivery
Several aspects of the CHD population and current care delivery system are important to consider in the context of performance reporting. Health care delivery for the approximately 40,000 patients undergoing congenital heart operations annually in the United States (US) is currently characterized by a decentralized system with a wide range of surgical volume across centers and many small-volume programs.15 In addition, there is wide variability in case-mix, or the type and severity of cases
Current State—Congenital Heart Surgery Performance Reports
In most other fields, performance reports are focused on the most common individual diagnoses or procedure types. For example, reporting efforts in adult cardiac surgery focus on coronary artery bypass grafting, mitral valve surgery, and aortic valve surgery.17 In congenital heart surgery, as described in the preceding sections, there is instead a widely heterogeneous group of diagnoses and procedures, many of which occur in relatively small numbers at any given center. Previous studies have
Understanding Case-Mix Adjusted Data
The most common methodology used in health care to account for case-mix when assessing performance is known as “indirect standardization” and involves the calculation of the observed-to-expected (O/E) ratio, which is the ratio of the actual (observed) number of deaths at the hospital to the number of deaths that what would be expected for the hospital’s particular case-mix. The expected value is generated from a statistical model that estimates the risk of death associated with various risk
Recommendations
Best practices in the reporting of hospital performance data have been published by numerous groups; however, these are often not followed.25,26 Adopting these practices in several key areas would likely promote more appropriate interpretation and understanding of reported performance data in congenital heart surgery. Central to this discussion is recognition that although the most common statistical methods used to construct hospital performance data allow program rating, rather than direct
Summary
Reporting and understanding hospital performance data in congenital heart surgery remains challenging. We offer several recommendations for further efforts that may aid in optimizing reporting methods, and the usefulness of this information for the stakeholders it is meant to serve. Improvements to our current system are imperative to avoid unintended consequences, such as adding confusion rather than clarity to families making decisions regarding where to seek care or promoting risk aversion
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