Encouraging Quality Improvement through the Use of a National Perfusion Database.

Abstract

On a daily basis, perfusionists may informally discuss aspects of quality improvement (QI), but the formal practice of QI is more difficult to operationalize. Efforts and expectations for QI may be limited by experience and/or available tools. In addition, high-quality data and sound analytic assessment are needed for the development and integration of evidence-based clinical guidelines. Since 2010, there have been developments within the perfusion community directed at fostering QI including 1) the creation of a national perfusion database endorsed by the American Society of Extracorporeal Technology (AmSECT) called PERFusion Measures and Outcomes (PERForm), 2) the establishment of a partnership between participating PERForm institutions in Michigan and Anthem Blue Shield Blue Cross, and 3) the redeployment of the AmSECT Quality Committee (AQC). The Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC) created the PERForm Registry in 2010. PERForm is a multi-institutional cardiovascular perfusion database focusing on the practice and outcome of cardiopulmonary bypass (CPB). PERForm data is linked with existing adult cardiac surgical databases and is used to provide a comprehensive and informed view of cardiovascular operative practices and their relation to clinical outcomes. This linkage allows for the creation and dissemination of quarterly benchmarking reports to facilitate quality assurance and improvement. Benchmarking reports are generated from variables abstracted from The PERForm Registry data entry form (1). Variables from this form are displayed against de-identified participating centers such that each participant can compare against their peers. For example, the proportion of cases where pump suckers were terminated “prior to, or at initiation of, protamine delivery” is displayed on a bar graph with participating centers numbered on the x-axis. Only members of each center are aware of the number assigned to their institution. Data review sessions are also conducted quarterly to promote collaboration among cardiovascular surgeons, perfusionists, data managers, administrators, and other healthcare professionals. Any perfusionist who participates in PERForm is invited to attend these quarterly meetings. A memorandum of understanding exists between the PERForm Registry and AmSECT, which establishes the mutual endorsement between the two entities. PERForm, the officially endorsed cardiovascular perfusion registry of AmSECT, supports AmSECT activities (particularly those related to quality assurance/QI) and promotes the development of national QI initiatives. The PERForm registry and AmSECT work symbiotically to encourage participation in a national perfusion registry, to engage more of the community in AmSECT membership, and to promote QI initiatives. PERForm and The Society of Thoracic Surgeons (STS) data are combined to create a more comprehensive view of the pre-op, intra-op, and post-op period. There are a series of steps that occur before these two data sets are merged. Data from the perioperative period is manually inputted into the PERForm Registry data entry form by the perfusionist or data manager for that institution. The party responsible for data entry and the frequency at which it is performed varies among institutions. As an example, each perfusionist may opt to enter the data following each case, a lead perfusionist may enter the data on a weekly basis, or the hospital’s data manager may complete entries monthly. Similarly, the party responsible for entering the data for the STS may vary but is typically the hospital’s data manager as many perfusion contract groups are limited to intraoperative data. The data entry form is housed by ARMUS, a third-party data management system that has the bandwidth to protect data privacy and provide analytics. Each quarter, the database analyst from the MSTCVS-QC submits a request to ARMUS to release the data and analytics generated from entries made into the PERForm data entry form. The MSTCVS-QC also receives data from the STS. There are five common data fields that exist between the STS and PERForm data that are cross matched to validate the data sets for