Contextual Data Displays, Easier Interpretation Represent Next Level in Public Reporting

STS News, Summer 2021 — Just as the STS National Database experience features more visual, easy-to-understand graphical data, so too does the STS Public Reporting program. Substantial changes have been implemented to improve the stakeholder experience.

These updates help participants better understand their performance and make real advances toward quality improvement—and view a more balanced representation of publicly reported results, said Benjamin D. Kozower, MD, MPH, chair of the Database’s Public Reporting Task Force. 

“In addition, the public reporting website has been redesigned and will be easier to use for the many different stakeholders seeking STS outcomes data,” Dr. Kozower said. These include patients, physicians, data managers, hospital executives, and marketing teams. 

Seeing More than Stars

The updated Public Reporting site presents individual participant group scores in addition to—and in comparison to—overall participant outcomes. Not only does a participant webpage publicly report a participant’s numeric score and range for each composite measure, it also displays a graph demonstrating where those unique scores fall in relation to overall STS participant ratings. For each composite measure and its domains, the corresponding graph incudes a participant’s results (represented by a black vertical line), the statistical credible intervals around the results (dark blue shading), the overall/average STS results (red line), and the lowest-to-highest range across all North American Adult Cardiac Surgery Database participants (light blue shading).

This contextual representation gives a realistic snapshot of what star ratings mean. With the new enhancements, publicly reported star ratings will always include a display of “out-of-how-many” possible stars, accompanied with a “Better Than Expected,” “As Expected,” or “Worse Than Expected” definition. 

 

ACSD Hospital-Level Reporting Eliminated

Since the STS Public Reporting initiative launched in 2010, results at both the participant group and hospital levels have been reported for the Adult Cardiac Surgery Database (ACSD), the largest registry component. While the majority of participant groups practice at only a single hospital, some practice at multiple locations. Correspondingly, some single hospitals house only one participant group, while other hospitals house multiple groups. 

Hospital-level results were not provided to participants prior to being publicly reported, whereas participant-level data matched harvest reports exactly. Understandably, participants as well as consumers found it confusing that a single site could have two slightly different results because of differences in the denominator populations. 

As a result, STS discontinued hospital-level reporting. This move matches the reporting system of the General Thoracic Surgery Database (GTSD), which also is publicly reported only at the participant level.

Overall Enhancements Enable More Participant- and Public-Friendly Experience

Visitors to the public reporting pages for ACSD, GTSD, and the Congenital Heart Surgery Database (CHSD) participants now have the convenience of a site-wide search feature pinned to the top of all pages, allowing them to search by participant group, hospital, or location, regardless of database component. 

For the ACSD pages, the site offers a search feature that is specific to ACSD participant surgery groups and the ability to search by location. Embedded maps on ACSD search and participant pages show hospital locations so that visitors may drill down via geographic location or view what’s in their local areas.

ACSD CABG and Multiprocedure Composite Measures on Horizon

“We’re very excited about a number of quality enhancements that will be implemented later this year and in early 2022,” said David M. Shahian, MD, chair of the STS Workforce on Quality. “The STS ACSD CABG composite measure, the first of our composites developed more than a decade ago, has now been updated to use 3-year analytic data windows and 95% credible intervals.”

This update makes the CABG composite methodology consistent with that of all subsequent ACSD composite measures, he explained. “These changes will help to more accurately classify the performance of lower-volume programs that consistently perform better or worse than expected, but whose 1-year sample sizes were too small to categorize them as outliers.”

STS also has developed an ACSD multiprocedure composite measure that drills down to the level of an STS participant, such as a medical center or a practice group, said Dr. Shahian. “This is similar to our individual surgeon composite measure developed in 2015. This new multiprocedure composite will provide a broad overview of a participant’s performance across all the major adult cardiac procedure types and is designed to complement individual procedure composite measures.”

STS Public Reporting is voluntary. Currently, 81% of ACSD participants, 91% of CHSD participants, and 44% of GTSD participants publicly report their outcomes. To learn more about the STS National Database, contact STSDB@sts.org.