Accountability: the future application of cardiothoracic surgical data in a changing health care environment

Abstract

There will be some very interesting and informative discussions this morning, which I think you will enjoy. Fred Grover is going to moderate the panel, but I wanted to make a few comments because I think data bases are a very important aspect of our future. I have had a personal interest in multiinstitutional data bases for more than 25 years. This was stimulated chiefly by my involvement in the Coronary Artery Surgery Study (CASS). Ward Kennedy made a presentation before the American Association for Thoracic Surgery 18 years ago [1], in which he showed variability in institutional operative mortality (Fig 1). The CASS Oversight Committee—now called the Safety and Data Monitoring Committee—visited the institutions with higher operative mortalities, examined their techniques and procedures, and made suggestions to improve the mortality statistics. The CASS study was a forerunner of the technique that has been used so successfully by the Northern New England Cardiovascular Disease Study Group. To my knowledge, it was the first time that the concept of observed-to-expected results was proposed publicly. I would like to offer this quote as an introduction to today’s discussion. “The practice of medicine will always be partly an art. But now, with information technology, with more research, and with professionals who combine clinical skills, it is possible to ground medical practice more in science as well as in art” [2].