Ethical Issues Confronting Outcomes Analysis and Quality Assurance
The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) has served as the primary, externally validated source for outcomes from its many participating centers. Because participation is voluntary and data are not publically reported, there exists a fundamental conflict with the overwhelming trend toward public reporting in both medicine and cardiac surgery. The ethical issues surrounding this conflict, as well as those involved in public reporting of complex congenital heart disease in general are described herein. The process by which adult cardiac surgery has come to initiate public reporting, while an important model for future directions in outcome reporting, does not adequately address the unique challenges that are faced by the reporting of congenital heart surgical outcomes. If these ethical issues are addressed and public reporting can be done in a responsible manner, then it should be undertaken by the leadership of physician-based groups such as the Society of Thoracic Surgeons.
KeywordsCongenital heart surgery Database Public reporting
- 1.Jacobs JP, Mavroudis C, Jacobs ML, Maruszewski B, Tchervenkov CI, Lacour-Gayet FG, Clarke DR, Gaynor JW, Spray TL, Kurosawa H, Stellin G, Ebels T, Bacha EA, Walters 3rd HL, Elliott MJ. Nomenclature and databases – the past, the present, and the future: a primer for the congenital heart surgeon. Pediatr Cardiol. 2007;28(2):105–15.PubMedCrossRefGoogle Scholar
- 2.Jacobs ML, Jacobs JP, Franklin RC, Mavroudis C, Lacour-Gayet F, Tchervenkov CI, Walters H, Bacha EA, Clarke DR, William Gaynor J, Spray TL, Stellin G, Ebels T, Maruszewski B, Tobota Z, Kurosawa H, Elliott M. Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease – the perspective of cardiac surgery. Cardiol Young. 2008;18 Suppl 2:101–15.PubMedCrossRefGoogle Scholar
- 3.Jacobs JP, Lacour-Gayet FG, Jacobs ML, Clarke DR, Tchervenkov CI, Gaynor JW, Spray TL, Maruszewski B, Stellin G, Gould J, Dokholyan RS, Peterson ED, Elliott MJ, Mavroudis C. Initial application in the STS congenital database of complexity adjustment to evaluate surgical case mix and results. Ann Thorac Surg. 2005;79:1635–49.PubMedCrossRefGoogle Scholar
- 6.Zinman D. State takes docs’ list to heart. New York Newsday. December 18, 1991:A7.Google Scholar
- 7.Coronary artery bypass graft surgery in New York State 1989–1991. Albany: New York State Department of Health; 1992.Google Scholar
- 11.Green J. Problems in the use of outcome statistics to compare health care providers. Brooklyn Law Rev. 1992;58:55–73.Google Scholar
- 13.Omoigui N, Annan K, Brown K, Miller D, Cosgrove D, Loop F. Potential explanation for decreased CABG related mortality in New York State: outmigration to Ohio. Circulation. 1994;90:I-93 (abstract).Google Scholar
- 14.Grossi EA, Green J, Galloway AC, et al. Surgical evaluation of high risk cases in the era of statewide cardiac surgery data reporting. Presented at the 20th meeting of the Western Society for Thoracic Surgery, Olympic Valley, 22–25 June 1994 (abstract).Google Scholar
- 15.Byer MJ. Faint hearts. New York Times. March 21, 1992:A23.Google Scholar
- 16.Society of Thoracic Surgeons. Welcome to the STS National Database. Available at: http://www.sts.org/sections/stsnationaldatabase/. Accessed 15 May 2013.
- 17.O’Brien SM, Jacobs JP, Clarke DR, Maruszewski B, Jacobs ML, Walters 3rd HL, Tchervenkov CI, Welke KF, Tobota Z, Stellin G, Mavroudis C, Hamilton JR, Gaynor JW, Pozzi M, Lacour-Gayet FG. Accuracy of the Aristotle Basic Complexity Score for classifying the mortality and morbidity potential of congenital heart surgery operations. Ann Thorac Surg. 2007;84:2027–37.PubMedCrossRefGoogle Scholar
- 21.Society of Thoracic Surgeons. STS reporting online. Available at: http://www.sts.org/quality-research-patient-safety/sts-public-reporting-online. Accessed 15 May 2013.
- 24.Society of Thoracic Surgeons. Potential unintended consequences. Available at: http://www.sts.org/quality-research-patient-safety/sts-public-reporting-online/potential-unintended-consequences-public. Accessed 15 May 2013.
- 25.The Denver Post Editorial Board. At the heart of the problem. Denver Post. March 2, 2001.Google Scholar
- 26.Sherry A. Children’s Hospital cardiology chief told to resign. Denver Post. March 1, 2001.Google Scholar
- 30.Strickland MJ, Riehle-Colarusso TJ, Jacobs JP, Reller MD, Mahle WT, Botto LD, Tolbert PE, Jacobs ML, Lacour-Gayet FG, Tchervenkov CI, Mavroudis C, Correa A. The importance of nomenclature for congenital cardiac disease: implications for research and evaluation. In: Jacobs JP, editor. 2008 Cardiology in the Young Supplement: Databases and The Assessment of Complications associated with The Treatment of Patients with Congenital Cardiac Disease. Prepared by: The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease. Cardiology in the Young, vol. 18, issue S2 (Suppl 2), p. 92–100, December 9, 2008.Google Scholar
- 31.Pasquali SK, Peterson ED, Jacobs JP, He X, Li JS, Jacobs ML, Gaynor JW, Hirsch JC, Shah SS, Mayer JE. Differential case ascertainment in clinical registry versus administrative data and impact on outcomes assessment for pediatric cardiac operations. Ann Thorac Surg. 2013;95(1):197–203.PubMedCentralPubMedCrossRefGoogle Scholar