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CardiacCase1.pptx

CardiacCase1.pptx

Department of Health Informatics

Health Information Management Program

BINF 5520 Health Analytics

Agenda

Understanding the Need for Preoperative Risk Assessment

Applying a “Bedside” Model of Open Heart Risk Assessment

Implementing the “Bedside” Model in a Second Hospital

Open Heart Risk Assessment Today: The Society for Thoracic Surgery (STS) Model

Implications for Health Analytics

Understanding the Need for Preoperative Risk Assessment and Stratification: The New York Experience

NYS Among First to Implement Cardiac Risk Model

Model Based on Earlier Work in New Jersey

Model Applied to All non-Federal Hospitals in NYS

Model Compared Both Hospitals and Providers

Model Calculates a Risk Adjusted Mortality Rate (RAMR)

Model Equalizes Results Based on a Hypothetical Statewide Case Mix

Health.ny.gov/statistics/diseases/cardiovascular/heart_disease/docs/2011-2013_adult_cardiac_surgery.pdf

Understanding the Need for Preoperative Risk Assessment and Stratification: The New York Experience

NYS Department of Health Report Summarizes:

Creation of RAMR Model

Data Collection Methods

Case Mix Assumptions

Description of Patient Population

Discussion of Critical Metrics

Impact on Quality Improvement

Health.ny.gov/statistics/diseases/cardiovascular/heart_disease/docs/2011-2013_adult_cardiac_surgery.pdf

Understanding the Need for Preoperative Risk Assessment and Stratification: The New York Experience

Table 1 compares both Observed and Risk-Adjusted Mortality Rates for Isolated CABG Surgery in NYS for 2013 discharges.

RAMR=Risk Adjusted Mortality Rate: the Provider’s Mortality Rate if the Provider’s case mix was identical to a hypothetical statewide case mix.

Health.ny.gov/statistics/diseases/cardiovascular/heart_disease/docs/2011-2013_adult_cardiac_surgery.pdf

Understanding the Need for Preoperative Risk Assessment and Stratification: The New York Experience

Table 6 presents the data by both Hospital and Provider.

Care was taken to collapse data when insufficient individual performance metrics were available.

This report was publically available via the NYS Department of Health website, and it can be found at the link below.

How did Cardiac Surgeons begin considering these issues?

These efforts actually started in the mid-1980s at a hospital in New Jersey.

Health.ny.gov/statistics/diseases/cardiovascular/heart_disease/docs/2011-2013_adult_cardiac_surgery.pdf

Developing and Implementing a “Bedside Estimation of Risk” Model of Open Heart Risk Stratification

This work, which was begun in the mid-1980s, discussed the need for the development of a clinical model which helps surgeons when discussing Open Heart Risk with patients.

The authors conclusively demonstrate the need for a “bedside scoring system” which facilitates provider-patient dialogue.

Many of the subsequent risk models were, in some part, based on this work.

Implementing the “Bedside” Model in a Second Hospital

The Canadian authors implement the model developed earlier in NJ to a population of cardiac patients at greater risk.

They discuss both the need for the development of a model as well as the factors that governed their selection of the appropriate risk model for their institution.

Ncbi.nlm.nih.gov/pmc/articles/PMC2651930

Implementing the “Bedside” Model in a Second Hospital

The Canadian authors describe the results that they obtained when applying the model developed in NJ to their patient cohort.

The results at the Canadian hospital compared favorably when applying the model developed in NJ.

They also discuss the need for adjusting baseline data based on clinical risk factors.

Ncbi.nlm.nih.gov/pmc/articles/PMC2651930

Where Are We Today With Regard To

Open Heart Risk Assessment ?

Many efforts worldwide have been implemented in pursuit of a better understanding of Preoperative Risk Assessment

In the United States, there has been a greater interest in this subject for clinical, administrative, and financial reasons.

Preoperative Risk Assessment has been accepted as normal part of administering a surgical program.

Preoperative Risk Assessment has been accepted by many non-cardiac disciplines, including orthopedic surgery, neurosurgical, and obstetrics.

There are many competing models of risk assessment within the cardiac surgery area. One that has met with widespread acceptance was developed by the Society for Thoracic Surgery (STS).

Components of the STS model are available on the web at this link:

riskcalc.sts.org/stswebriskcalc/#/

Open Heart Risk Assessment Today: The Society for Thoracic Surgery (STS) Model

In the intervening years, many groups associated with Open Heart surgery have developed various models of Risk Assessment.

One of the most widely used models was developed by the Society for Thoracic Surgery (STS) and was based somewhat on earlier models, including the NJ and NY efforts.

The STS Model, which is accessible at the link below, enables the provider to input key risk factors and then observe the predicted risk mortality for that individual patient based on data used in a national model.

riskcalc.sts.org/stswebriskcalc/#/

Open Heart Risk Assessment Today: The Society for Thoracic Surgery (STS) Model

In the intervening years, many groups associated with Open Heart surgery have developed various models of Risk Assessment.

This model is easy to use and for members of the STS, it comes with comprehensive user documentation and training.

riskcalc.sts.org/stswebriskcalc/#/

Open Heart Risk Assessment Today: The Society for Thoracic Surgery (STS) Model

riskcalc.sts.org/stswebriskcalc/#/

The model requires the user to enter a number of different factors which are then compared to the STS National Database.

Over the years, the STS has expanded their model to incorporate both isolated CABG surgery as well as a wide range of the cardiac surgical procedures.

Open Heart Risk Assessment Today: The Society for Thoracic Surgery (STS) Model

In addition to providing the surgeon with risk mortality data based on procedure, the model predicts other indicators which are helpful to the surgeon when discussing the prognosis with the patient.

Some aspects of these risk assessment models have now been incorporated into the Quality Resource Management discipline within many healthcare enterprises.

Open Heart Risk Assessment Today: The Society for Thoracic Surgery (STS) Model

riskcalc.sts.org/stswebriskcalc/#/

An important aspect to the development of any risk assessment model is whether or not it can change over time to become better at predicting surgical outcome.

All models must have the capacity to incorporate new technology. In the case of Cardiac Surgery, the development of a greater number of minimally invasive procedures has necessitate these changes.

Open Heart Risk Assessment Today: The Society for Thoracic Surgery (STS) Model

riskcalc.sts.org/stswebriskcalc/#/

Once the model have been concluded for a given patient, the model permits the user to begin another patient.

Some Practical Analytical Implications for the Health Informaticist

What are the data collection challenges that face the Health Informaticist?

How do we establish a “baseline” which will be used for comparative purposes?

What metrics are used to determine “Success”, “Failure”, or other designations when considering the assessment or surgical risk?

What are the challenges associated with transporting and/or applying a model between multiple institutions?

How it Works

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NB

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Regards,

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