Does openness improve outcome the north west quality improvement program
Download
1 / 27

Does Openness Improve Outcome ? The North-West Quality Improvement Program - PowerPoint PPT Presentation


  • 100 Views
  • Uploaded on

Does Openness Improve Outcome ? The North-West Quality Improvement Program. Dr R H Stables Cardiothoracic Centre Liverpool. Acknowledgements. Dr Mark Jackson PhD [email protected] Mr Anthony D Grayson, BSc [email protected]

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Does Openness Improve Outcome ? The North-West Quality Improvement Program' - aldona


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Does openness improve outcome the north west quality improvement program

Does Openness Improve Outcome ?The North-West Quality Improvement Program

Dr R H Stables

Cardiothoracic Centre Liverpool


Acknowledgements
Acknowledgements


Nwqip
NWQIP

  • Collaboration between 4 centres (now 5!)

  • Manchester Royal Infirmary

  • Blackpool Victoria Hospital

  • Wythenshawe Hospital

  • Cardiothoracic Centre Liverpool

  • NW Regional Cardiac Surgery Audit project

  • Extended to PCI activity


Nwqip1
NWQIP

  • High quality clinical data collection and validation

  • Creation of a central registry

  • Development of analysis techniques

  • Application to real clinical issues

  • Multi-disciplinary peer review visits

  • Partnership with primary care and patients


Nwqip examples of product
NWQIP - Examples of Product

  • Observational research


Observational research
Observational Research

  • 1 Newall N, Grayson AD, Oo AY, Palmer ND, Dihmis WC, Rashid A, et al. Preoperative white blood cell count is independently associated with higher perioperative cardiac enzyme release and increased 1-year mortality after coronary artery bypass grafting.[see comment]. Annals of Thoracic Surgery 2006 Feb;81(2):583-9.

  • 2 Reddy SL, Grayson AD, Oo AY, Pullan MD, Poonacha T, Fabri BM, et al. Does off-pump surgery offer benefit in high respiratory risk patients? A respiratory risk stratified analysis in a propensity-matched cohort. European Journal of Cardio-Thoracic Surgery 2006 Jul;30(1):126-31.

  • 3 Kubal C, Srinivasan AK, Grayson AD, Fabri BM, Chalmers JA, Kubal C, et al. Effect of risk-adjusted diabetes on mortality and morbidity after coronary artery bypass surgery. Annals of Thoracic Surgery 2005 May;79(5):1570-6.

  • 4 Karthik S, Srinivasan AK, Grayson AD, Friede T, Fabri BM, Karthik S, et al. Effect of the left internal mammary artery to the left anterior descending artery on mortality and morbidity after combined coronary and valve operations. Annals of Thoracic Surgery 2005 Jul;80(1):163-9.

  • 5 Lu JC, Grayson AD, Pullan DM, Lu JCY, Grayson AD, Pullan DM. On-pump versus off-pump surgical revascularization for left main stem stenosis: risk adjusted outcomes.[see comment]. Annals of Thoracic Surgery 2005 Jul;80(1):136-42.


Observational research 2002 2006
Observational Research 2002 - 2006

  • Original peer review publications - 42

  • Influence on surgical outcome of :

    • CP bypass (On-pump v Off-pump)

    • Aortic manipulation and CVA risk

    • Myocardial protection strategies

    • Pre-operative aspirin therapy

    • Timing of IABP support

    • Pre-operative anaemia ……….


Nwqip examples of product1
NWQIP - Examples of Product

  • Observational research

  • ‘Professional issues’ and outcomes

    • Early years of independent consultant practice

    • Case volume and adverse events

  • The development of risk stratification tools

  • Continuous performance monitoring


Professional issues and outcomes
Professional Issues and Outcomes

  • The ‘learning curve effect’ in cardiac surgery

  • First years of independent consultant practice

  • Examining risk adjusted mortality

BMJ 2004; 329: 421-4



Professional issues and outcomes1
Professional Issues and Outcomes

  • Case volume and outcomes

  • 8572 consecutive isolated CABG

  • Mean number of cases per consultant 372

  • Examining risk adjusted mortality

BMJ 2003; 327: 13-17


Results1

5

4

3

2

1

100

200

300

400

500

600

Results

Mortality %

1

Case Numbers


Development of risk stratification

Heart 2006; 92: 658-63

Development of Risk Stratification

BMJ 2003; 327: 13-17


Performance monitoring
Performance Monitoring

  • Surgeon specific mortality data

  • Isolated CABG (and AVR)

  • CUSUM analysis

  • Risk adjusted to regional norm

  • 85% confidence limits





Ctc pci mace 2002 2004
CTC PCI: MACE 2002 - 2004

* MACE includes in-hospital mortality,

Q-wave MI, and emergency CABG

% of Patients


Ctc pci mace 2002 20041
CTC PCI: MACE 2002 - 2004

* MACE includes in-hospital mortality,

Q-wave MI, and emergency CABG

% of Patients



Extending performance assessment
Extending Performance Assessment

  • Non-MACE adverse outcomes



Extending performance assessment1
Extending Performance Assessment

  • Winners aim to achieve success

    • NOT to avoid failure

  • Measures of completeness and quality

    • Procedural data

    • Repeat revascularisation

    • Symptoms and quality of life



Ctc pci mace 2001 2003
CTC PCI: MACE 2001 - 2003

* MACE includes in-hospital mortality,

Q-wave MI, and emergency CABG

% of Patients


Ctc pci mace 2001 20031
CTC PCI: MACE 2001 - 2003

* MACE includes in-hospital mortality,

Q-wave MI, and emergency CABG

% of Patients


ad