On Continuous Improvement in the STS National Database

Robert A. Wynbrandt, Executive Director & General Counsel
DeLaine Schmitz, Director of Quality

STS News, Summer 2013 -- Continuing the STS management team’s series of guest columns for STS News, DeLaine Schmitz provides a timely update on the latest initiatives related to our crown jewel, the STS National Database. In her capacity as Director of Quality, DeLaine oversees STS activities in the areas of patient safety and evidence-based surgery, as well as the operations of the STS National Database and its quality-related byproducts; she also works closely with Fred Edwards, Cynthia Shewan, and the STS Research Center team on research initiatives based on the STS National Database. DeLaine joined us in April 2012 after a 14-year tenure at the American Society of Plastic Surgeons, most recently serving as its Senior Director of Quality Initiatives.

As the STS 50th Anniversary approaches and members contemplate the many achievements that have taken place over the past five decades, the creation of the STS National Database in 1989 stands out as one of the organization’s finest accomplishments. Over the years, the Database has become a powerful tool that is highly regarded in the medical, governmental, policy, and payer communities. Due to the capabilities of the National Database and the Society’s associated initiatives, STS has earned a leadership role in the national and international quality arenas. Analogous to the 1970s E. F. Hutton commercials, when the STS National Database is quoted, people listen.

A noteworthy accomplishment for the Database in 2013 was the July launch of a web-based anesthesia module within the Adult Cardiac Surgery Database. This long-anticipated collaborative project between STS and the Society of Cardiovascular Anesthesiologists (SCA) provides an opportunity for anesthesiologists to join their cardiac surgeon colleagues in the collection of adult cardiac anesthesia data. A dedicated anesthesia report section will be incorporated in the main quarterly harvest reports for review by both surgeon and anesthesiologist participants. The anesthesia data collection form and data specifications created by SCA representatives, in consultation with Duke Clinical Research Institute and STS staff, are located on the STS website. To obtain information regarding anesthesiology module participation, contact STS National Database Operations Manager Gerry Tarafa at gtarafa [at] sts [dot] org.

The STS Public Reporting initiative is another prime example of an important and continuously growing STS National Database activity, and in January 2013, aortic valve replacement (AVR) composite star ratings became available for public reporting. For the 2013 “harvest one” public reporting period that will be posted online in August, 464 Adult Cardiac Surgery Database participant sites will be publicly reporting their coronary artery bypass grafting (CABG) and/or AVR composite star ratings on the STS website voluntarily. New composite measures are currently in various stages of development and will provide further public reporting opportunities in the future. With a 3-year contract between the Society and Consumers Union recently completed, the option to also publicly report via Consumer Reports will remain available through 2015.

International participation, another recent initiative, is now open for all three components of the Database, with the General
Thoracic Surgery Database becoming available for international participation earlier this year. International representation has expanded to include four countries. Surgeons in Brazil, Israel, Turkey, and Jordan participate in the Adult Cardiac Surgery Database, and surgeons in Turkey also participate in the Congenital Heart Surgery Database.

It is estimated that more than 200 STS member surgeons, research scientists, data managers, and other health care professionals are actively engaged in leadership activities that relate directly to the care and feeding of the STS National Database (and this is distinct from the population of STS members involved in closely related research, education, and advocacy initiatives); this represents a level of commitment that is remarkable, even by STS standards, and is the envy of other medical specialty societies. These individuals follow in the footsteps of previous STS visionary leaders who continually strived to move the Database forward and meet the challenges of the time. This positive trend is evident in 2013 as participation in all three component databases continues to grow, specification upgrades are devised and executed, risk-adjustment models are updated, and new initiatives are launched. This continual process improvement will be supported this year by a 1.5 day Database Think Tank meeting in September, bringing together a group of stakeholders to look toward the future and plan the steps necessary to help ensure that the Database continues to be a robust, powerful resource for many years to come. Any suggestions or comments for Think Tank participants should be directed to STS Director of Quality DeLaine Schmitz at dschmitz [at] sts [dot] org.

And especially for our data manager Associate Members—but also for surgeon and anesthesiologist participants alike—it’s not too early to start planning for your attendance at our 10th production of Advances in Quality & Outcomes (AQO): A Data Managers Meeting, scheduled for September 26-28 in Boston. The annual AQO conference represents a unique opportunity to witness STS National Database continuous improvement in action; registration is available at www.sts.org/aqo.