Postcrisis redevelopment of sustainable healthcare systems.

Objective: Research and field experience have identified a global gap in postdisaster rebuilding of healthcare systems due to the current primary focus on returning devastated community infrastructures to predisaster conditions. Disasters, natural or man-made, present an opportunity for communities to rebuild, restructure, and redefine their predisaster states, creating more resilient and sustainable healthcare systems.

Design: A model for sustainable postdisaster healthcare rebuilding was developed by bridging identified gaps in the literature on the processes of developing healthcare systems postdisaster and utilizing evidence from the literature on postdisaster community reconstruction.

Successful linking of the Society of Thoracic Surgeons Database to Social Security data to examine the accuracy of Society of Thoracic Surgeons mortality data.

Objectives: The Society of Thoracic Surgeons Adult Cardiac Surgery Database has been linked to the Social Security Death Master File to verify "life status" and evaluate long-term surgical outcomes. The objective of this study is explore practical applications of the linkage of the Society of Thoracic Surgeons Adult Cardiac Surgery Database to Social Securtiy Death Master File, including the use of the Social Securtiy Death Master File to examine the accuracy of the Society of Thoracic Surgeons 30-day mortality data.

Methods: On January 1, 2008, the Society of Thoracic Surgeons Adult Cardiac Surgery Database began collecting Social Security numbers in its new version 2.

Graduate medical education leadership development curriculum for program directors.

Objective: Program director (PD) orientation to roles and responsibilities takes on many forms and processes. This article describes one institution's innovative arm of faculty development directed specifically toward PDs and associate PDs to provide institutional resources and information for those in graduate medical education leadership roles.

Methods: The designated institutional official created a separate faculty development curriculum for leadership development of PDs and associate PDs, modeled on the Association of American Medical Colleges-GRA (Group on Resident Affairs) graduate medical education leadership development course for designated institutional officials.

Successful linking of the Society of Thoracic Surgeons database to social security data to examine survival after cardiac operations.

Background: Long-term evaluation of cardiothoracic surgical outcomes is a major goal of The Society of Thoracic Surgeons (STS). Linking the STS Database to the Social Security Death Master File (SSDMF) allows for the verification of "life status." This study demonstrates the feasibility of linking the STS Database to the SSDMF and examines longitudinal survival after cardiac operations.

Successful linking of the Society of Thoracic Surgeons adult cardiac surgery database to Centers for Medicare and Medicaid Services Medicare data.

Background: The Centers for Medicare and Medicaid Services (CMS) Medicare database complements The Society of Thoracic Surgeons (STS) database by providing information about long-term outcomes and cost. This study demonstrates the feasibility of linking STS data to CMS data and examines the penetration, completeness, and representativeness of the STS database.

Methods: Using variables common to both STS and CMS databases, STS operations were linked to CMS data for all CMS coronary artery bypass graft surgery (CABG) hospitalizations discharged between 2000 and 2007, inclusive.

The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 3--valve plus coronary artery bypass grafting surgery.

Background: Since 1999, The Society of Thoracic Surgeons (STS) has published two risk models that can be used to adjust the results of valve surgery combined with coronary artery bypass graft surgery (CABG). The most recent was developed from data for patients who had surgery between 1994 and 1997 using operative mortality as the only endpoint. Furthermore, this model did not specifically consider mitral valve repair plus CABG, an increasingly common procedure.

The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2--isolated valve surgery.

Background: Adjustment for case-mix is essential when using observational data to compare surgical techniques or providers. That is most often accomplished through the use of risk models that account for preoperative patient factors that may impact outcomes. The Society of Thoracic Surgeons (STS) uses such risk models to create risk-adjusted performance reports for participants in the STS National Adult Cardiac Surgery Database (NCD).

The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1--coronary artery bypass grafting surgery.

Background: The first version of The Society of Thoracic Surgeons National Adult Cardiac Surgery Database (STS NCD) was developed nearly 2 decades ago. Since its inception, the number of participants has grown dramatically, patient acuity has increased, and overall outcomes have consistently improved. To adjust for these and other changes, all STS risk models have undergone periodic revisions.

Regulatory and ethical considerations for linking clinical and administrative databases.

Clinical data registries are valuable tools that support evidence development, performance assessment, comparative effectiveness studies, and the adoption of new treatments into routine clinical practice. Although these registries do not have important information on long-term therapies or clinical events, administrative claims databases offer a potentially valuable complement. This article focuses on the regulatory and ethical considerations that arise from the use of registry data for research, including linkage of clinical and administrative data sets.

Does preoperative atrial fibrillation increase the risk for mortality and morbidity after coronary artery bypass grafting?

Objectives: Preoperative atrial fibrillation has been associated with less favorable outcomes in patients undergoing coronary artery bypass grafting. However, it was never investigated in a large cohort of patients using a national database. This study aims to (1) identify the effect of atrial fibrillation on operative mortality and morbidity in patients undergoing isolated coronary artery bypass grafting and (2) identify the potential effect of atrial fibrillation on patients with decreased left ventricular ejection fraction ( View Article and Find Full Text PDF

A model to begin to use clinical outcomes in medical education.

The latest phase of the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project challenges graduate medical education (GME) programs to select meaningful clinical quality indicators by which to measure trainee performance and progress, as well as to assess and improve educational effectiveness of programs. The authors describe efforts to measure educational quality, incorporating measurable patient-care outcomes to guide improvement. University of Florida College of Medicine-Jacksonville education leaders developed a tiered framework for selecting clinical indicators whose outcomes would illustrate integration of the ACGME competencies and their assessment with learning and clinical care.

Clinical characteristics and in-hospital outcomes of patients with cardiogenic shock undergoing coronary artery bypass surgery: insights from the Society of Thoracic Surgeons National Cardiac Database.

Background: There exist few studies that characterize contemporary clinical features and outcomes or risk factors for operative mortality in cardiogenic shock (CS) patients undergoing coronary artery bypass grafting (CABG).

Methods And Results: We evaluated data of 708,593 patients with and without CS undergoing CABG enrolled in the Society of Thoracic Surgeons National Cardiac Database (2002-2005). Clinical, angiographic, and operative features and in-hospital outcomes were evaluated in patients with and without CS.

Comparison of cardiac surgery volumes and mortality rates between the Society of Thoracic Surgeons and Medicare databases from 1993 through 2001.

Background: This study compares surgical volumes and mortality rates in the Society of Thoracic Surgeons voluntary clinical National Cardiac Database (NCD) with those from an administrative claims database (Medicare Provider Analysis and Review [MedPAR]) to assess the suitability of the NCD for tracking national cardiac surgery outcomes.

Methods: Hospitals common to both databases were matched. In each database, patients aged 65 years and older who underwent coronary artery bypass grafting, aortic valve replacement, and mitral valve replacement in United States hospitals from 1993 to 2001 were identified.

Impact of residency status on perfusion times and outcomes for coronary artery bypass graft surgery.

Background: A price of training residents in cardiothoracic surgery is often perceived to be a loss in intraoperative efficiencies, leading to prolonged cardiopulmonary bypass and perfusion time. Because these indicators are also thought to adversely affect operative outcome, we investigated the association between residency training status, perfusion times, and outcomes.

Methods: Using the Society of Thoracic Surgeons (STS) National Cardiac Database, we studied 369,906 CABG patients undergoing isolated coronary artery bypass graft (CABG) procedures during January 2002 through June 2005.

Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline.

Background: A minority of patients having cardiac procedures (15% to 20%) consume more than 80% of the blood products transfused at operation. Blood must be viewed as a scarce resource that carries risks and benefits. A careful review of available evidence can provide guidelines to allocate this valuable resource and improve patient outcomes.