A star-based system for rating the performance of more than 200 U.S. thoracic surgery programs doing isolated coronary artery bypass surgery went live on the Consumer Reports Health Web site on Sept. 7, using data collected and analyzed by the Society of Thoracic Surgeons.
On a subscription-only site, Consumer Reports Health lists the names, locations, and a one- to three-star rating for 221 U.S. cardiothoracic surgery practices that perform coronary artery bypass grafting (CABG), participate in the Society of Thoracic Surgeons (STS) database, and agreed to have their rating released to the public. About 90% of the more than 1,000 U.S. thoracic surgery practices that perform CABG participate in the STS database.
The 221 listed practices included 50 with a three-star rating (defined as above-average performance on several process and outcomes measures); 166 with a two-star (average) rating; and 5 with a one-star (a below-average performance) rating. The October issue of Consumer Reports also published the names and locations of the 50 three-star practices.
The launch of this ranking of CABG programs culminates an effort begun by STS officials in early 2009, when they approached the Consumers Union, publisher of Consumer Reports Health, to map out a strategy to create the listing. The STS promoted the program during its annual meeting in January, aiming to list more than 300 practices. The 221 initial participants – fewer than a quarter of the U.S. programs offering CABG – falls short of that number and notably runs short on one-star (below average) programs.
The STS members who developed the data assessment methodology used an approach that produced roughly equal numbers of high and low outliers, the above- and below-average subgroups. The current analysis designated about 10%-15% of the CABG programs as above average, and a similar percentage as below average, with roughly three-quarters tagged as two stars (average), said Dr. David M. Shahian, professor of surgery at Harvard Medical School, Boston, and chairman of the society's national database workforce. Now that the inaugural report is out, several practices not yet involved will feel “pressure to participate” from both patients and payers, and will sign on to be part of next year's list, Dr. Shahian said in an interview.
“I think it's pretty remarkable” that 22% were willing to participate in the initial listing, he said. “I have done several conference calls to answer questions [about the listing], and I did not hear a single comment that this is philosophically wrong.” Many programs opted to wait to see how the initial list rolled out, he added.
The methods he and his associates developed to distinguish the three tiers of programs will result in smaller percentages of above- and below-average designations if several low-scoring programs improve. The analysis method has a high level of sensitivity to detect high and low outliers, and high specificity so outlier groups truly deserved their designations. The method has a 99% probability that the three- and one-star programs truly differ from the programs that got two stars.
The list included an overall practice assessment based on four domains of CABG care, and each individual domain received a one- to three-star rating (Ann. Thorac. Surg. 2007;83[suppl. 4]:S3-12).
The four domains of care are:
▸ Operative care focused on whether patients received at least one internal mammary-artery graft.
▸ Risk-adjusted operative mortality.
▸ Perioperative medical care focused on preoperative beta-blocker use and on discharge prescribing of aspirin, a beta-blocker, and a lipid-lowering regimen.
▸ Postoperative morbidity, including renal insufficiency, deep sternal wound infection, and reexploration for any cause, as well as stroke or prolonged ventilation.
Dr. Shahian said he had no conflicts of interest to disclose.