The STS National Database Today
In order to participate in the STS Adult Cardiac Surgery Database, surgical groups contractually agree to enter data on every eligible heart surgery procedure they perform. Random audits are performed by an independent auditing firm to verify accurate and complete data collection. At specified times each year, all the data from individual sites are submitted to Duke Clinical Research Institute (DCRI), which serves as the data warehouse and analysis center for the Database. DCRI then consolidates all the data, conducts statistical analyses, and provides a feedback report to each Database participant. That feedback report allows the individual surgical group participant to compare its results to national standards and pinpoint areas that would benefit from more focused attention.
The Database reports are particularly meaningful because of their ability to account for the severity of illness using statistical risk models that adjust the observed outcomes (e.g., mortality rates) based on severity of illness. These risk-adjusted outcomes ensure that there is an “apples to apples” approach when results from different centers are examined.
All physicians want to improve the care provided to their patients. Experience with the Database has shown that hospitals and surgical groups can continually improve care by establishing feedback loops that enable surgeons to make appropriate changes based on real clinical data. Over the past two decades, patients undergoing CABG surgery have presented with more risk factors, often of greater severity than in earlier periods, and this logically should have lead to higher rates of operative mortality. In fact, results from the STS Database have demonstrated a progressive reduction in operative mortality.
There has been an increased national focus on the quality of health care over the last 20 years. New developments have been carefully monitored by STS leadership, with appropriate changes being incorporated into the Database structure and function. From a tool used primarily for local quality improvement in 1989, the Database has evolved into an instrument that influences national health care policy. It will always maintain its primary purpose as a quality improvement tool at the local level, but it is now also a true national resource and a leading example of professional accountability and commitment to patient care.
Analyses suggest that the STS Database has enrolled more than 90 percent of cardiothoracic programs in the U.S. Studies comparing CMS and STS data demonstrate high penetration, completeness, and representativeness in the Medicare population (Jacobs et al. Successful linking of the Society of Thoracic Surgeons adult cardiac surgery database to Centers for Medicare and Medicaid Services Medicare data. Ann Thorac Surg. 2010 Oct;90(4):1065-6).