Surgeon-Specific Quality Monitoring System for Coronary Artery Bypass Grafting

Abstract

We developed a multidimensional quality monitoring system using an electronic health care records-derived database, and mobile-based reports for individual cardiovascular surgeons. This study included surgeons who performed coronary artery bypass graft surgery at a single center in China from January to December 2015. Patient data were automatically derived from structured electronic health records. Surgeon-specific quality measures included inhospital mortality and morbidity, transfusion-free procedure, use of internal mammary artery, postoperative length of stay, and hospitalization cost. The"technique for order of preference by similarity to ideal solution" method was used to create a composite quality measure and rank surgeons on performance. Surgeons were rated into three categories: the top 20%, middle 20% to 80%, and the bottom 20%. Quality data were delivered to surgeons through mobile-based reports. Forty surgeons performed 4,288 coronary artery bypass graft surgeries in 2015. For surgeons in the top, middle, and bottom performance categories, there was a trend of increase in risk adjusted inhospital morbidity rate (2.66%, 2.89%, and 3.07%, respectively; p= 0.5101). There were significant differences in the use of internal mammary artery (94.65%, 95.8%, 90.14%, respectively; p < 0.0001), risk-adjusted postoperative length of stay (7.01 days, 7.99 days, and 8.69 days, respectively; p < 0.0001), and hospitalization cost(81.27 thousand yuan, 88.36 thousand yuan, and 102.77 thousand yuan, respectively; p < 0.0001). We developed a surgeon-specific quality monitoring system using structured electronic health records-derived database, multidimensional measures, and mobile-based reporting. This system will facilitate quality reporting and peer comparison, and strengthen the effect of quality improvement.