Michigan consortium shares heart data

CABG is focus

Hospitals in southeast Michigan have been tracking heart care performance for a couple of years. And while some facilities were brought "kicking and screaming" into the process, they now recognize that it’s an effective way to compare costs and better quality and outcomes.

"Some hospitals were put off at first by having to supply this outcomes data," says James Jackson Jr., director of the Southeast Michigan Regional Heart Consortium (SMRHC) in Detroit. "But eventually they came to terms with it. Someone put it this way, ‘Whether you like this or not, we’ve been saying for the last several years that more and more physician and hospital data are going to be out there. You might as well participate so you can at least influence the way it will be described.’"

SMRHC is a partnership of heart care centers, physicians, purchasers, payers, government agencies, and consumers. At first the consortium was comprised of only nine out of the 12 adult heart care facilities in the area. "The other three inevitably fell out of the loop and realized it was in their best interests to be a part," says Jackson.This fall the SMRHC released its Cardiac Services Information Guide which reflects the volume levels of cardiovascular procedures for its 12 hospitals and affiliated physicians. Adjusted for risk, the data are there for the public to see so they can make more informed decisions about their health care. They also serve as accurate benchmarks for institutions to check their data against. Diagnostic catheterizations, angioplasties, bypass surgeries, and electrophysiology studies are included as well as information on physician certification and experience.

Data have to be risk-adjusted

"We decided several years back that we needed comparative health care information so we could make some decisions about improving quality and keeping costs down," says Jackson. "When we asked hospital representatives for that information, however, one would invariably protest, explaining that its facility’s numbers couldn’t be equated to another’s because ‘our folks are sicker than their folks.’ Clearly rigorous risk-adjustment was imperative — we had to devise a system where each facility collecting data worked with the same set of definitions."

The consortium has been collecting data since July 1996 concerning the appropriateness of interventions, clinical outcomes, the mix of services available, and resource utilization. SMRHC’s initial focus is coronary artery bypass graft (CABG) surgeries, and there are about 2,000 cases in the database. "Our goal is to help providers improve quality and efficiency," says Jackson.

The consortium has achieved a number of successes:

- halted the proliferation of unneeded open heart surgery programs in the region;

- developed appropriateness indicators for CABG surgery, angioplasty, and angiography;

- designed and implemented the Cardiac Services Information System, a unique prospective case level collection strategy that utilizes uniform definitions and vigorously case-adjusted patient and cost data;

- developed a community-based prevention initiative integrating education, counseling, behavior modification, and wellness services as well as an interactive video technology patient information tool on ischemic heart disease and its treatment options.