President's Column: Patients First

Robert S.D. Higgins, MD, MSHA

“The only way to make sense out of change is to plunge into it, move with it, and join the dance.”
—Alan W. Watts

STS News, Fall 2019 — Autumn is associated with the end of summer holidays, the start of a new school year, hurricane season, and the beginning of football season. With the change of seasons comes new hope for the academic year, full of promise and excitement tempered by the challenges that any change in season represents.

So too is the resolve and efforts of the STS surgeon leader and staff teams to continue the work of our specialty during these times of change to improve the well-being of patients with cardiovascular and thoracic diseases. Central to these efforts has been a primary focus on modernization and optimization of our national database. Our staff has been working tirelessly to transition the warehousing capabilities to IQVIA, an internationally renowned database technology management group, to facilitate a next generation that will be a cloud-based database. This system will provide rapid feedback, reports, and dashboards with unadjusted and risk-adjusted outcomes. As we move this initiative forward, we anticipate partnering with database managers, coordinators, and surgical programs to pilot these "real-time dashboards," all the time trying to reduce the data collection burden by 30%. We need and welcome your help during this exciting time!

Patient Focused, Quality Based, Mission Driven

In the final analysis, all of our efforts come back to the patient first. Since 1964, STS and its members have been dedicated to ensuring the best possible outcomes for patients with diseases of the heart, lung, and esophagus. Millions of patients have been affected, and even saved, by these efforts.

The STS National Database was established in 1989 as an initiative for quality improvement and patient safety. Since that time, it has evolved into the premier clinical registry for cardiothoracic surgery with a national leadership profile and international reputation. A separate clinical registry, the STS/ACC TVT Registry, recently has been instrumental in critical decisions by CMS, the FDA, and other regulatory agencies determining our specialties’ continued mandatory participation and financial compensation.

The successes and accomplishments as a result of these registries have been made in partnership with other members of the multidisciplinary team—cardiologists, nurses, perfusionists, anesthesiologists, and critical care specialists—all contributing to data repositories, tracking patient safety and real-world outcomes related to coronary artery bypass grafting, valve surgeries, thoracic and congenital procedures, and, most recently, innovative procedures such as transcatheter aortic valve replacement.

All of our efforts come back to the patient first.

Primarily because of these collaborations within and across specialties, we continue to advocate for the best interests of our patients… working together, we continue to maintain our impact in cardiovascular medicine, using data to support better patient outcomes. We look forward to maintaining a strong cardiovascular workforce speaking with one voice because united we stand, and divided we will fall!

As many of you are aware, our colleagues in highly specialized areas such as congenital heart surgery face increasing pressure around risk-adjusted outcomes reporting. We value their life-saving skill, impact, and efforts to report accurate, timely, understandable, risk-adjusted outcomes that reflect the extraordinary work that our congenital and pediatric surgical teams provide. STS has always had a primary goal to maintain its mission of transparency and enhancing patient safety through its public reporting efforts.

The fundamental goal of risk-adjusted outcomes is to compare a provider’s results for his/her specific patients, with results that would be expected on a reference standard or benchmark.

We understand that comprehensive risk assessment is a challenge, given the complexity of variables influencing congenital surgical procedures. For this reason, we have engaged database content experts to evaluate our risk adjustment model, as well as appointed an ad hoc task force, led by world-class STS leaders in the congenital surgery field, to provide content expertise and advice about public reporting outcomes. In the future, we recognize that there may be tremendous opportunity to partner with our colleagues at AATS and work together on these efforts related to the congenital database. Stay tuned as we explore working together to meet the needs of our patients, the public, and our specialty. 

As we kick off the fall season, we want to recognize that STS has been fortunate to have the service of Chris Draft, a former college football standout and 12-year NFL linebacker, as its Public Director. Of even greater importance has been Chris’s foundation (The Chris Draft Family Foundation), which is working to fight lung cancer on behalf of his wife, Keasha, who lost her courageous fight and died as a nonsmoker at the age of 38. Thanks to Chris and patient advocates like him who join STS in raising awareness about lung cancer. The work we are doing makes it easier for survivors to become survivor advocates. Please join us as we serve the needs of our patients and fulfill the STS mission.

Remember, it is all about the patient!