The Impact of Public Reporting on Procedural Outcomes Following Congenital Heart Surgery

项目摘要/摘要 Natalie Jayaram，医学硕士，密苏里大学堪萨斯分校儿科学助理教授 City和儿童慈悲医院儿科和心脏科的一名教员 密苏里州堪萨斯城的一家医院。作为一名儿科心脏病专家和卫生服务研究员，她的长期 职业目标是通过以下方式改善先天性心脏病(CHD)儿童患者的护理 通过检查保健方面基于政策的举措的有效性，以及通过 直接与患者合作，促进医疗服务的变革。当前项目的目标是研究公众 报告先天性心脏病手术(CHS)。公共报告旨在为医疗保健消费者提供 具有给定提供者或机构的结果数据。公开报道的支持者倡导透明 披露健康结果数据，并争辩说，公开报告有助于改善结果。1-4批评 公共报告援引证据表明，公共报告可能不会显著改善结果，并可能导致 意外后果，包括规避风险的做法。5-14关于公众的影响的正式研究 从来没有对社区卫生服务的结果进行报告。冠心病护理的高度专业性， 与更普遍的疾病(例如成人心血管疾病)相比，当地或地区的竞争相对较少 疾病)，但由于患者愿意前往寻求最好的治疗，15建议对CHS的公共报告 需要进行独立调查。拟议项目的主要目标是：1)评估是否 公共报道的一个意想不到的后果是，患者病例组合发生了变化，这表明 可以避免对预后较差的高危患者进行手术干预2)评估 CHS公共报告的实施与手术结果之间的关系，以及3)更好地 了解CHD患者及其家属认为最有意义的数据类型和格式 他们在知情的情况下做出关于护理的决定。研究目标1和2建议从以下方面获取数据 国家住院病人数据库，以研究公共报告、机构病例组合、 以及美国各地进行CHS的中心的手术结果。研究目标3提出焦点小组 让冠心病患者和护理人员更好地了解他们在以下方面的偏好 公开报道。贾亚拉姆博士与她的指导团队一起，致力于创造一种职业发展 计划，这将为她提供更多的培训、教育和高级统计领域的经验 方法，使用管理数据的经验，以及定性研究和 耐心参与。总体而言，从这个项目和教育计划中学到的技能，加上 优秀的指导团队将使Jayaram博士实现她成为独立医生的最终目标 儿科心血管结局研究领域的研究员和领导者。

PROJECT SUMMARY/ABSTRACT Natalie Jayaram, MD MSB is an Assistant Professor of Pediatrics at the University of Missouri-Kansas City and a faculty member in the Department of Pediatrics and Division of Cardiology at Children’s Mercy Hospital in Kansas City, Missouri. As a pediatric cardiologist and health services researcher, her long-term career goals are to improve the care of pediatric patients with congenital heart disease (CHD) by contributing to the science of quality assessment, by examining the effectiveness of policy-based initiatives on care, and by partnering directly with patients to facilitate changes in care. The goal of the current project is to study public reporting for congenital heart surgery (CHS). Public reporting is designed to provide healthcare consumers with outcome data for a given provider or institution. Proponents of public reporting advocate for transparent disclosure of health outcomes data and contend that public reporting results in improved outcomes.1-4 Critics of public reporting cite evidence that public reporting may not substantially improve outcomes and could result in unintended consequences, including risk avoidance practices.5-14 Formal study regarding the impact of public reporting on outcomes for CHS has never been performed. The highly specialized nature of CHD care, with relatively less local or regional competition compared to more prevalent conditions (e.g. adult cardiovascular disease) but with patients willing to travel to seek the ‘best’ care,15 suggest that public reporting for CHS warrants independent investigation. The primary aims of the proposed project are: 1) to evaluate whether, as an unintended consequence of public reporting, there is a shift in patient case mix, suggesting that centers could be avoiding surgical intervention in patients at highest risk for poor outcome 2) to evaluate the association between implementation of public reporting for CHS and surgical outcomes, and 3) to better understand the type and format of data that CHD patients and families would find most meaningful to help them make informed decisions regarding care. Study aims 1 and 2 of the project propose obtaining data from the State Inpatient Database in order to study the association between public reporting, institutional case mix, and surgical outcomes at centers throughout the US performing CHS. Study Aim 3 proposes focus groups involving CHD patients and caregivers to gain an improved understanding of their preferences with regards to public reporting. Together with her mentorship team, Dr. Jayaram has worked to create a career development plan that will provide her with additional training, education, and experience in the areas of advanced statistical methodology, experience in working with administrative data, and formal training in qualitative research and patient engagement. Overall, the skills learned from this project and educational plan coupled with an outstanding mentorship team will allow Dr. Jayaram to achieve her ultimate goal of becoming an independent investigator and leader in the field of pediatric cardiovascular outcomes research.