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Improving Quality of Care in Cardiac Surgery: Evaluating Risk Factors, Processes of Care, Structures of Care, and Outcomes

Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, Colorado, Northport Department of Veterans affairs Medical Center, Northport, New York, annie.shroyer{at}va.gov

Gerald O. McDonald, MD

Department of Veterans Health Affairs Central Office, Washington, DC

Brandie D. Wagner, PhD

Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, Colorado

Randy Johnson, MS

Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, Colorado

Lisa M. Schade, MBA

Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, Colorado

Missy R. Bell, MBA, MSHA

Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, Colorado

Frederick L. Grover, MD

Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, Colorado, Department of Surgery, University of Colorado at Denver and Health Science Center, Denver, Colorado

The 1985 release of hospital report cards by the Health Care Financing Administration awakened the public's awareness of variations in outcomes following patient treatment. In 1972, the Department of Veterans Affairs initiated an oversight process for all VA-based cardiac surgery programs. In response to Public Law 99-166, the Continuous Improvement in Cardiac Surgery Program (CICSP) national database was developed in 1987. This CICSP effort reported variations in outcomes across VA cardiac programs. In 1997, the CICSP expanded (CICSP-X) to identify the interrelationships of risk factors with processes and structures of care, as well as clinical outcomes. Based on VA findings to date, these quality improvement endeavors appear to have positively affected short-term and longer-term cardiac surgical outcomes. To advance a new patient-focused paradigm for continuous improvement in cardiac surgical care quality for all US citizens, an integrated data-driven reporting approach with broad-based participation should be implemented to optimally improve patient care.

Key Words: risk factor • coronary artery bypass • process assessment • quality assurance • quality indicators • outcome assessment

Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 12, No. 3, 140-152 (2008)
DOI: 10.1177/1089253208323060


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