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Eur J Cardiothorac Surg. 2016 Jun;49(6):1660-9. doi: 10.1093/ejcts/ezw034. Epub 2016 Mar 16.

First results of a national initiative to enable quality improvement of cardiovascular care by transparently reporting on patient-relevant outcomes.

Author information

1
AMC Heart Center, Department of Cardio-Thoracic Surgery, Academic Medical Center at the University of Amsterdam, Amsterdam, Netherlands.
2
AMC Heart Center, Department of Cardio-Thoracic Surgery, Academic Medical Center at the University of Amsterdam, Amsterdam, Netherlands b.a.demol@amc.uva.nl.

Abstract

OBJECTIVES:

The aims of this study were to assess patient-relevant outcomes of delivered cardiovascular care by focusing on disease management as determined by a multidisciplinary Heart Team, to establish and share best practices by comparing outcomes and to embed value-based decision-making to improve quality and efficiency in Dutch heart centres.

METHODS:

In 2014, 12 Dutch heart centres pooled patient-relevant outcome data, which resulted in transparent publication of the outcomes, including long-term follow-up up to 5 years, of approximately 86 000 heart patients. This study presents the results of both disease- and treatment patient-relevant outcome measures for coronary artery disease and aortic valve disease. The patients included were presented to a Heart Team and underwent invasive or operative treatment. In-hospital and out-of-hospital patient-relevant outcome measures were collected as well as initial conditions. Quality of life was assessed using the Short Form (SF)-36 or SF-12 health survey.

RESULTS:

In the Netherlands, patient-relevant and risk-adjusted outcomes of cardiovascular care in participating heart centres are published annually. Data were sufficiently reliable to enable comparisons and to subtract best practices. The statistically lower risk-adjusted mortality rate after coronary artery bypass grafting resulted in a voluntary roll-out of a perioperative safety check. The in-depth analysis of outcomes after percutaneous coronary intervention resulted in process improvements in several heart centres, such as pre-hydration for patients with renal insufficiency and the need of target vessel revascularizations within a year.

CONCLUSION:

Annual data collection on follow-up of patient-relevant outcomes of cardiovascular care, initiated and organized by physicians, appears feasible. Transparent publication of outcomes drives the improvement of quality within heart centres. The system of using a limited set of patient-relevant outcome measures enables reliable comparisons and exposes the quality of decision-making and the operational process. Transparent communication on outcomes is feasible, safe and cost-effective, and stimulates professional decision-making and disease management.

KEYWORDS:

Cardiovascular; Outcomes; Patient-relevant; Quality improvement; Transparency; Value-based healthcare

PMID:
26984991
DOI:
10.1093/ejcts/ezw034
[Indexed for MEDLINE]

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