STS News, Fall 2019 — The Society’s ongoing and multifaceted effort to optimize the value and utility of the STS National Database is moving full steam ahead, with one major enhancement nearing completion and several others due for release early next year.
Using street addresses and geocoding technology, STS has collaborated with Northwestern University’s Center for Health Information Partnerships to obtain socioeconomic data corresponding to the majority of the nearly 8 million records in the Adult Cardiac Surgery Database (ACSD), the General Thoracic Surgery Database (GTSD), and the Congenital Heart Surgery Database (CHSD). The socioeconomic data include information on income classification, education level, household crowding, deprivation score, and other details from the US Census and American Community Survey.
“Supplementing our clinical database with socioeconomic status data will provide unique opportunities to better understand the impact of social determinants on outcomes in cardiothoracic surgery,” said Kevin W. Lobdell, MD, chair of the STS Workforce on Research Development. “It will help us develop insight into access and disparities so that we can personalize care for each patient’s unique needs.”
Connecting socioeconomic data to records in the Intermacs Database is expected in 2020, along with an annual linkage to new records thereafter in all four Database components.
Longitudinal Outcomes Data Coming Soon
The next evolution of the Database will focus on longitudinal patient follow-up. Currently, the ACSD, GTSD, and CHSD track a single hospitalization for up to 30 days after surgery. In the coming months, these data will be connected to reoperations at other hospitals, as well as national mortality data.
Reoperation follow-up will be derived by internally linking procedure records corresponding to the same patient within the entire Database, whether surgery is performed at the same institution or any other participating institution in the US. Longitudinal survival data will come from linking with the Centers for Disease Control and Prevention’s National Death Index (NDI), a repository of death record information from state vital statistics offices that includes information such as when a person died and cause of death.
"The integration of longitudinal reoperation data and NDI data will transform the STS National Database into a powerful multiyear follow-up clinical registry. This is a major leap forward for the entire specialty," said Vinay Badhwar, MD, chair of the STS Council on Quality, Research, and Patient Safety. "Access to longitudinal data may help us answer important questions to serve quality improvement and clinical decision-making as we continue on our collective aim to find the best long-term therapy for our patients."
"This is a major leap forward for the entire specialty."
Dr. Lobdell added that the combination of STS National Database data and socioeconomic, reoperation, and longitudinal information will improve risk assessment and help refine risk mitigation strategies.
“This is a game-changing development that will allow us to more comprehensively assess a patient’s individual characteristics and circumstances and employ a data-driven approach to determine the best revascularization technique or valve replacement method, for example,” he said.
Access to these data for research projects will be available through the STS Research Center.
Charts and graphs will allow quick visualization of a participant’s data, including patient demographics.
Interactive Dashboards under Development
In addition to the ongoing Database augmentation project, the Society is working with surgeons and data managers to develop enhanced tools for data entry and display through IQVIA, the new data warehouse for the Database.
New, dynamic dashboards will offer immediate, 24/7 access to a participant’s data. The technology will facilitate presentation of data in easily digestible charts and graphs that allow for quick visualization of high-level case details such as total cases, readmissions, mortality, and risk-adjusted outcomes. Database participants also will be able to change the parameters to look at benchmarks from previous analytic windows and compare their own performance by time period, like groups, and national averages.
In addition, the dashboards will allow a participant to see which cases meet thresholds in terms of data entry, which cases require attention, and which cases have been flagged for potential errors such as out-of-range data. As a result, participants will be able to identify errant data quickly and easily.
The new dashboards will be available in January. STS and IQVIA will continue making improvements based on participant feedback over the subsequent months.
ACSD Data Collection Refined
When the next ACSD data specification upgrade goes live on July 1, 2020, the number of overall data fields will be reduced by at least 30%.
A team of surgeons, data managers, and STS staff responded to concerns that data collection was too onerous and came up with a number of recommendations, including:
- Refining the way fields capture data, using different formatting techniques such as multiple choice;
- Adjusting parent-child relationships to make sure that fields are captured only if they are relevant to the case;
- Retiring or reworking fields that were not often completed because of the difficulty in abstracting these fields;
- Removing fields that were not necessary for quality measurement; and
- Modifying the aorta section so that the data capture is less burdensome.
Sites can still add customized fields using their own vendor software.
More details on the transformative changes under way for the Database, including demonstrations of the new dashboards, will be shared at Advances in Quality & Outcomes: A Data Managers Meeting, October 23-25 in New Orleans, Louisiana. Additional information also will be provided in the next issue of STS News.