Health care quality improvement for cardiovascular surgery in China: the perspectives and initiatives_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QU Jianyu ¹ , ZHAO Yan ² ,  ZHENG Zhe ¹

1. Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, 100037, P.R.China;
2. National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;

Corresponding author：

ZHENG Zhe, Email: zhengzhe@fuwai.com

Keywords：

Cardiovascular surgery; outcomes research; evaluation indictor system; quality improvement

DOI：

10.7507/1007-4848.201909034

Video：

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The cardiovascular surgery in China has reached a stable platform, with notable progress been achieved in the past several decades. However, significant divergency regarding the healthcare quality was also observed, which requiring effective intervention to start the transition from the focus on "quantity" to the pursuit of "quality". Quality improvement program, including the establishment of a national cardiovascular surgery database, the conformation of a standard key quality evaluation indicator system, and the conduction of quality intervention and improvement initiatives, are promising to consolidate and expand the advantages of cardiac surgery and lead to better patient outcomes.

Citation： QU Jianyu, ZHAO Yan, ZHENG Zhe. Health care quality improvement for cardiovascular surgery in China: the perspectives and initiatives. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(11): 1054-1059. doi: 10.7507/1007-4848.201909034 Copy

1.	Yuan X, Zhang H, Zheng Z, et al. Trends in mortality and major complications for patients undergoing coronary artery bypass grafting among urban teaching hospitals in China: 2004 to 2013. Eur Heart J Qual Care Clin Outcomes, 2017, 3(4): 312-318.
2.	Zheng Z, Zhang H, Yuan X, et al. Comparing outcomes of coronary artery bypass grafting among large teaching and urban hospitals in China and the United States. Circ Cardiovasc Qual Outcomes, 2017, 10(6): pii: e003327.
3.	Jiang L, Krumholz HM, Li X, et al. Achieving best outcomes for patients with cardiovascular disease in China by enhancing the quality of medical care and establishing a learning health-care system. Lancet, 2015, 386(10002): 1493-1505.
4.	Hu S, Zheng Z, Yuan X, et al. Coronary artery bypass graft: contemporary heart surgery center performance in China. Circ Cardiovasc Qual Outcomes, 2012, 5(2): 214-221.
5.	Taylor MJ, McNicholas C, Nicolay C, et al. Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Qual Saf, 2014, 23(4): 290-298.
6.	Bhatt DL, Drozda JP Jr, Shahian DM, et al. ACC/AHA/STS statement on the future of registries and the performance measurement enterprise: A report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and The Society of Thoracic Surgeons. J Am Coll Cardiol, 2015, 66(20): 2230-2245.
7.	Maddox TM, Albert NM, Borden WB, et al. The learning health care system and cardiovascular care: a scientific statement from the American Heart Association. Circulation, 2017, 135(14): e826-e857.
8.	Kaafarani HMA, Eid AI, Antonelli DM, et al. Description and impact of a comprehensive multispecialty multidisciplinary intervention to decrease opioid prescribing in surgery. Ann Surg, 2019, 270(3): 452-462.
9.	Khuri SF, Daley J, Henderson W, et al. The Department of Veterans Affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA surgical quality improvement program. Ann Surg, 1998, 228(4): 491-507.
10.	Ghali WA, Ash AS, Hall RE, et al. Statewide quality improvement initiatives and mortality after cardiac surgery. JAMA, 1997, 277(5): 379-382.
11.	O'Brien SM, Shahian DM, DeLong ER, et al. Quality measurement in adult cardiac surgery: part 2--Statistical considerations in composite measure scoring and provider rating. Ann Thorac Surg, 2007, 83(4 Suppl): S13-S26.
12.	Shahian DM, Edwards FH, Ferraris VA, et al. Quality measurement in adult cardiac surgery: part 1--Conceptual framework and measure selection. Ann Thorac Surg, 2007, 83(4 Suppl): S3-S12.
13.	Jacobs JP, Shahian DM, D'Agostino RS, et al. The Society of Thoracic Surgeons national database 2018 annual report. Ann Thorac Surg, 2018, 106(6): 1603-1611.
14.	Society of Thoracic Surgeons (STS). https://publicreporting.sts.org/. Updated 2019/9/1. Accessed.
15.	ElBardissi AW, Aranki SF, Sheng S, et al. Trends in isolated coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons adult cardiac surgery database. J Thorac Cardiovasc Surg, 2012, 143(2): 273-281.
16.	Li X, Lu J, Hu S, et al. The primary health-care system in China. Lancet, 2017, 390(10112): 2584-2594.
17.	Grover FL, Shroyer AL, Hammermeister K, et al. A decade's experience with quality improvement in cardiac surgery using the Veterans Affairs and Society of Thoracic Surgeons national databases. Ann Surg, 2001, 234(4): 464-472.
18.	Rao C, Zhang H, Gao H, et al. The Chinese cardiac surgery registry: design and data audit. Ann Thorac Surg, 2016, 101(4): 1514-1520.
19.	国家心血管病质控中心专家委员会心外科专业组. 中国心血管外科质量改善项目: 冠状动脉旁路移植术关键质量评价指标体系专家共识. 中华胸心血管外科杂志, 2018, 34(5): 257-273.
20.	Gulliford MC, Prevost AT, Charlton J, et al. Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care: REDUCE cluster randomised trial. BMJ, 2019, 364: l236.
21.	Holman WL, Sansom M, Kiefe CI, et al. Alabama coronary artery bypass grafting project: results from phase II of a statewide quality improvement initiative. Ann Surg, 2004, 239(1): 99-109.
22.	Jones DA, Rathod KS, Koganti S, et al. The association between the public reporting of individual operator outcomes with patient profiles, procedural management, and mortality after percutaneous coronary intervention: an observational study from the Pan-London PCI (BCIS) registry using an interrupted time series analysis. Eur Heart J, 2019, 40(31): 2620-2629.
23.	Goldenberg MG, Grantcharov TP. A novel method of setting performance standards in surgery using patient outcomes. Ann Surg, 2019, 269(1): 79-82.
24.	Tricco AC, Ivers NM, Grimshaw JM, et al. Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis. Lancet, 2012, 379(9833): 2252-2261.
25.	Granger CB, Xavier D. Improving evidence for implementation of guideline-based care in low- and middle-income countries. JAMA, 2018, 319(6): 554-556.
26.	Johnson SH, Theurer PF, Bell GF, et al. A statewide quality collaborative for process improvement: internal mammary artery utilization. Ann Thorac Surg, 2010, 90(4): 1158-1164.
27.	Likosky DS, Zhang M, Paone G, et al. Impact of institutional culture on rates of transfusions during cardiovascular procedures: The Michigan experience. Am Heart J, 2016, 174: 1-6.
28.	Desai NR, Ott LS, George EJ, et al. Variation in and hospital characteristics associated with the value of care for medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia. JAMA Netw Open, 2018, 1(6): e183519.
29.	Moore GF, Audrey S, Barker M, et al. Process evaluation of complex interventions: medical research council guidance. BMJ, 2015, 350: h1258.

1. Yuan X, Zhang H, Zheng Z, et al. Trends in mortality and major complications for patients undergoing coronary artery bypass grafting among urban teaching hospitals in China: 2004 to 2013. Eur Heart J Qual Care Clin Outcomes, 2017, 3(4): 312-318.
2. Zheng Z, Zhang H, Yuan X, et al. Comparing outcomes of coronary artery bypass grafting among large teaching and urban hospitals in China and the United States. Circ Cardiovasc Qual Outcomes, 2017, 10(6): pii: e003327.
3. Jiang L, Krumholz HM, Li X, et al. Achieving best outcomes for patients with cardiovascular disease in China by enhancing the quality of medical care and establishing a learning health-care system. Lancet, 2015, 386(10002): 1493-1505.
4. Hu S, Zheng Z, Yuan X, et al. Coronary artery bypass graft: contemporary heart surgery center performance in China. Circ Cardiovasc Qual Outcomes, 2012, 5(2): 214-221.
5. Taylor MJ, McNicholas C, Nicolay C, et al. Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Qual Saf, 2014, 23(4): 290-298.
6. Bhatt DL, Drozda JP Jr, Shahian DM, et al. ACC/AHA/STS statement on the future of registries and the performance measurement enterprise: A report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and The Society of Thoracic Surgeons. J Am Coll Cardiol, 2015, 66(20): 2230-2245.
7. Maddox TM, Albert NM, Borden WB, et al. The learning health care system and cardiovascular care: a scientific statement from the American Heart Association. Circulation, 2017, 135(14): e826-e857.
8. Kaafarani HMA, Eid AI, Antonelli DM, et al. Description and impact of a comprehensive multispecialty multidisciplinary intervention to decrease opioid prescribing in surgery. Ann Surg, 2019, 270(3): 452-462.
9. Khuri SF, Daley J, Henderson W, et al. The Department of Veterans Affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA surgical quality improvement program. Ann Surg, 1998, 228(4): 491-507.
10. Ghali WA, Ash AS, Hall RE, et al. Statewide quality improvement initiatives and mortality after cardiac surgery. JAMA, 1997, 277(5): 379-382.
11. O'Brien SM, Shahian DM, DeLong ER, et al. Quality measurement in adult cardiac surgery: part 2--Statistical considerations in composite measure scoring and provider rating. Ann Thorac Surg, 2007, 83(4 Suppl): S13-S26.
12. Shahian DM, Edwards FH, Ferraris VA, et al. Quality measurement in adult cardiac surgery: part 1--Conceptual framework and measure selection. Ann Thorac Surg, 2007, 83(4 Suppl): S3-S12.
13. Jacobs JP, Shahian DM, D'Agostino RS, et al. The Society of Thoracic Surgeons national database 2018 annual report. Ann Thorac Surg, 2018, 106(6): 1603-1611.
14. Society of Thoracic Surgeons (STS). https://publicreporting.sts.org/. Updated 2019/9/1. Accessed.
15. ElBardissi AW, Aranki SF, Sheng S, et al. Trends in isolated coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons adult cardiac surgery database. J Thorac Cardiovasc Surg, 2012, 143(2): 273-281.
16. Li X, Lu J, Hu S, et al. The primary health-care system in China. Lancet, 2017, 390(10112): 2584-2594.
17. Grover FL, Shroyer AL, Hammermeister K, et al. A decade's experience with quality improvement in cardiac surgery using the Veterans Affairs and Society of Thoracic Surgeons national databases. Ann Surg, 2001, 234(4): 464-472.
18. Rao C, Zhang H, Gao H, et al. The Chinese cardiac surgery registry: design and data audit. Ann Thorac Surg, 2016, 101(4): 1514-1520.
19. 国家心血管病质控中心专家委员会心外科专业组. 中国心血管外科质量改善项目: 冠状动脉旁路移植术关键质量评价指标体系专家共识. 中华胸心血管外科杂志, 2018, 34(5): 257-273.
20. Gulliford MC, Prevost AT, Charlton J, et al. Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care: REDUCE cluster randomised trial. BMJ, 2019, 364: l236.
21. Holman WL, Sansom M, Kiefe CI, et al. Alabama coronary artery bypass grafting project: results from phase II of a statewide quality improvement initiative. Ann Surg, 2004, 239(1): 99-109.
22. Jones DA, Rathod KS, Koganti S, et al. The association between the public reporting of individual operator outcomes with patient profiles, procedural management, and mortality after percutaneous coronary intervention: an observational study from the Pan-London PCI (BCIS) registry using an interrupted time series analysis. Eur Heart J, 2019, 40(31): 2620-2629.
23. Goldenberg MG, Grantcharov TP. A novel method of setting performance standards in surgery using patient outcomes. Ann Surg, 2019, 269(1): 79-82.
24. Tricco AC, Ivers NM, Grimshaw JM, et al. Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis. Lancet, 2012, 379(9833): 2252-2261.
25. Granger CB, Xavier D. Improving evidence for implementation of guideline-based care in low- and middle-income countries. JAMA, 2018, 319(6): 554-556.
26. Johnson SH, Theurer PF, Bell GF, et al. A statewide quality collaborative for process improvement: internal mammary artery utilization. Ann Thorac Surg, 2010, 90(4): 1158-1164.
27. Likosky DS, Zhang M, Paone G, et al. Impact of institutional culture on rates of transfusions during cardiovascular procedures: The Michigan experience. Am Heart J, 2016, 174: 1-6.
28. Desai NR, Ott LS, George EJ, et al. Variation in and hospital characteristics associated with the value of care for medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia. JAMA Netw Open, 2018, 1(6): e183519.
29. Moore GF, Audrey S, Barker M, et al. Process evaluation of complex interventions: medical research council guidance. BMJ, 2015, 350: h1258.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Health care quality improvement for cardiovascular surgery in China: the perspectives and initiatives

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