Perhaps you are considering a hospital in a different state and this does not apply to your situation. In other cases your insurance company will only cover certain hospitals and you may feel like the choice has already been made for you. However, if you had the opportunity to compare two or three hospitals in your area would you like to know which hospital had fewer post operative infections after open heart surgery? What about the rates of readmission after you have been sent home? What about other post operative risks? If you had the opportunity to review such information and make your final decision I believe you would take the time and research hospital data. However, where would you start? This is exactly why I had a desire to complete this article and provide at best a compass to help you navigate your decision regarding surgeon and heart hospital.
I must confess that as I started researching what California offered in respect to public hospital cardiac data I was naively expecting quick results. However, the more I researched this subject the clearer it became that hospital heart data reporting is quite an extensive subject and varies widely state by state. Therefore, the more I attempted to make sense of my findings the more it became apparent that I needed someone’s insight to help me tie it all together. Therefore, I decided to reach out to Dr. Joseph Carey a cardiothoracic surgeon out of the University of California Irvine Medical Center and member of the Board of Directors for the California Society of Thoracic Surgeons to help me better understand the current climate for California’s cardiac public reporting outcomes. I wanted to meet with Dr. Carey because I felt that researching this topic and developing this article would be incomplete without his personal input. I am happy to say that I was able to meet with Dr. Carey and it was a privilege to be able to discuss this topic with him candidly and openly.
Therefore, as a result of my findings and Dr. Carey clarifying certain areas I decided to provide a FAQ format for your ease and convenience. I chose to highlight what I found to be the most relevant for heart patient and caregiver seeking information regarding heart surgery ratings and data for California hospitals.
What is heart or cardiac outcome public reporting?
The hospital’s cardiac surgical outcomes that are released to the public. In many cases this data is submitted to state health departments and/or the Society of Thoracic Surgeons. ‘STS believes the public has a right to know the quality of surgical outcomes and considers public reporting an ethical responsibility of the specialty’.
Why should I consider cardiac outcome reports?
It is a personal choice to consider reviewing cardiac data outcomes for a given hospital. The information is oftentimes scientific in nature and difficult to interpret. However, such reports have helped hospitals’ performance and as a result improved outcomes for the heart patient such as mortality rates declining since 2003 the first year of mandated reporting in California.
What type of heart outcome data is important?
Please note that this is a suggested list only. Every patient needs to speak directly with their surgeon regarding open heart surgery and its potential risks and complications.
- Volume of heart surgeries performed
- Success rate of procedure
- Risks of procedure
- Stroke risk after procedure
- Readmission rates after being discharged
- Infection or other complications related to procedure
- Patient safety
- Average hospital stay
- Nursing care
Does the law require that California hospitals report cardiac procedures?
Absolutely! Under state law California-licensed hospitals are required to report all isolated and non-isolated coronary artery bypass graft surgeries (CABG) to California’s Office of Statewide Health Planning and Development (OSHPD). Isolated CABG surgery is defined as CABG surgery performed without other major procedures, such as valve repair or carotid endarterectomy during the same surgery.
I am having coronary artery bypass graft in a California hospital. Where can I find more information about CABG and the hospital’s outcomes?
A great starting place is the Coronary Artery Bypass Graft Report through California’s Office of Statewide Health Planning and Development.
I am having open heart surgery to correct a heart valve problem. Is there a public report for heart valve replacement or repair in California?
Unfortunately, California does not currently have a public report available to the consumer for heart valve surgery. However, through the California Cardiac Surgery and Intervention Project a patient is able to research valve surgery volumes in the state as some hospitals have larger volumes than others. However, the patient and family member should not be discouraged by this and should ask the hospital directly for their cardiac outcome reports pertaining to heart valve surgeries.
What is CCSIP?
The California Cardiac Surgery Intervention Project is a grant funded project by the California Society of Thoracic Surgeons to collect data and maintain best practices. Its cardiac data is geared for heart surgeons and hospitals to use in the quality improvement process. (Therefore a consumer is not able to view certain areas as it’s tailored for hospitals and surgeons only and requiring a membership fee).
CCSIP’s data is obtained from the patient discharge (PDD), emergency department (ED), and ambulatory surgery (AS) databases of the California Office of Statewide Health Planning and Development (OSHPD). CCSIP’s mission is to reach surgeons and hospitals. If you desire to learn more about CCSIP’s data collection, please review their Q and A. Please be advised that it is very detailed and designed for those wishing to understand the parameters behind how data is collected.
When will valve replacement or repair surgeries be reported publicly in California?
A bill (SB 830) has been introduced which will allow OSHPD to report outcomes of percutaneous coronary intervention (PCI) and heart valve procedures. Dr. Carey’s thoughts are that it will probably take 3-5 years to see this legislation passed and implemented.
Is there a list that shows me how many heart surgeries are performed by California heart hospitals?
Yes, through CCSIP you can find a summary of Cardiac Procedure Volumes.
What other resources are available?
CalQuality.org-provides ratings of California hospitals and medical centers for patient experience, patient safety, re-hospitalizations or readmissions, infections, complications, death or mortality rates, timeliness and effectiveness for various conditions and procedures.
Consumer Reports-compiled a report on Hospital Ratings Heart Surgery. Please scroll down to California to view hospitals in our state. You may also search hospital ratings by cities or counties at Consumer Reports for a small fee.
Society of Thoracic Surgeons-receives heart surgical data from hospitals on a voluntary basis.
Leapfrog-believes in providing the consumer transparent results. The Los Angeles Times recently published, ‘How safe is your hospital? A look at Calfornia Ratings’ based on Leapfrog’s information.
Can I find a quality report card for the insurance companies treating heart disease in California?
Although this does not fall exactly under hospital ratings it is nonetheless an important angle to consider as a patient is able to review the heart care ratings that their insurance coverage provides.
Why does it matter?
I appreciate the way Maggie Lichtenburg sums it up in The Open Heart Companion. This is a small excerpt from her book: ‘Hospitals’ reputations span from excellent to poor, and everything in between, when it comes to:
- Hygiene protocols
- State of the art technology than can dramatically improve the safety of surgery
- Staffing of cardiac surgery nurses and technicians
- National standard comparison for heart surgery department’
Why does it matter? It matters because your life will be in their care and depending on the hospital’s cardiac data or ratings it has the potential to greatly influence your surgery, care, and recovery.
What does this mean for you?
If you are a heart patient requiring coronary artery bypass graft then cardiac reports are available to you at the state level. However, if you need a heart valve repair or replacement where do you seek your information? Dr. Carey points out that the patient or family member can always ask the hospital directly for their cardiac outcome reports if the information is not available at the state level. In addition, a patient has the option to review heart hospital ratings through trusted sources such as Consumer Reports.
Until more hospital cardiac data is available to the public in California it is clear that the patient and family member needs to ask the facility directly for their outcome reports or seek third party sources to find hospital ratings. It is equally important that the surgeon is transparent and is willing to discuss the hospital’s statistics with you as the patient. If he or she is not willing to share this information it might be an indication that you may want to go elsewhere for your heart surgery.
With that said I would love to hear how this article has helped you as you research your heart hospital options. If there is anything that I missed or you would like more information about please leave me a comment below.
I would also like to thank Dr. Carey for spending time with me to discuss CASTS and it’s role in Calfornia’s cardiac outcome reporting status. In closing, this is from my correspondence with Dr. Carey.
‘Aida, thanks for reaching out to us. The California Society of Thoracic Surgeons is dedicated to improving the care of patients requiring cardiovascular interventions through its outcome reporting projects, collaborative programs, research and meetings for healthcare professionals. We would like to be more “patient-centered” to use a term made popular through the Affordable Care Act, but our success in this area is limited. For this reason applaud your efforts and hope you will continue to network with other groups as we work to respond to this vital need’.
California CABG Outcomes Reporting Program (CCORP) Data Abstractor Training Handbook Version 2.0 http://www.oshpd.ca.gov/hid/SubmitData/CCORP_CABG/2006AbstractTrain.pdf. Accessed Dec 27, 2014
California Cardiac Intervention Project: http://www.californiacardiacsurgery.com/CCSIP-2012/
California Heart Surgeons: http://www.californiacardiacsurgeons.com/index.php?menuIndex=1
Consumer Reports. Heart Ratings Heart Hospital: http://www.consumerreports.org/content/dam/cro/news_articles/health/PDFs/CU-HospitalRating6-23-14v2.pdf. Accessed Dec 27, 2014
Frankel N. Surgical Aortic Valve Replacement vs Transcatheter Aortic Valve Replacement: A Consumer’s Perspective Regarding Data Education and Transparency of Hospitals. JAMA Intern Med. 2014;174(4):495-496. doi:10.1001/jamainternmed.2013.12829.
Licentenberg, M. (2006) The Open Heart Companion: Preparation and Guidance for Open Heart Surgery Recovery. New Mexico: Open Heart Publishing.
Office of Statwide Health Planning and Development. Press Release. Mortality Rates Continue to Decline. http://www.oshpd.ca.gov/General_info/Press_Room/pressreleases/2011/CABGPressRelease_June8_2011.pdf. Accessed Dec 27, 2014
Ritley D. and Romano P. The State of Cardiac Revascularization Outcomes Reporting. Davis, CA: University of California, Davis, Center for Healthcare Policy and Research, 2011. http://www.oshpd.ca.gov/HID/Products/Clinical_Data/CABG/CardiacRevascularization.pdf. Accessed Oct 1, 2014
State of California Office of Statewide Health Planning and Development. Healthcare Information Division. Coronary Artery Bybass Graft Surgery in California http://www.oshpd.ca.gov/hid/Products/Clinical_Data/CABG/. Accessed Dec 27, 2014
Terhune Chad and Smith D. Los Angeles Times. How safe is your hospital? A look at California ratings. Accessed January 20, 2015
The California Report on Coronary Artery Bypass Graft Surgery. http://www.oshpd.ca.gov/HID/Products/Clinical_data/CABG/2011/CABG2011.pdf. Accessed Dec 27, 2014
Senate Committee on Health Bill Analysis. http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0801-0850/sb_830_cfa_20140422_165607_sen_comm.html.Accessed Dec 27, 2014
Society of Thoracic Surgeons: http://www.sts.org/quality-research-patient-safety/sts-public-reporting-online
US News Best Hospital Rankings: http://health.usnews.com/best-hospitals/rankings/cardiology-and-heart-surgery/data