Monitoring the performance of cardiac surgeons Graeme L Hickey 1 ; Stuart W Grant 2 ; Camila Caiado 3 ; Iain Buchan 1 ; Ben Bridgewater 1,2 1 Northwest Institute of BioHealth Informatics, Manchester University 2 Department of Cardiothoracic Surgery, University Hospital of South Manchester 3 Department of Mathematical Sciences, Durham University
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Monitoring the performance of cardiac surgeons Graeme L Hickey 1 ; Stuart W Grant 2 ; Camila Caiado 3 ; Iain Buchan 1 ; Ben Bridgewater 1,2 1 Northwest.
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Monitoring the performance of cardiac surgeonsGraeme L Hickey1; Stuart W Grant2; Camila Caiado3; Iain Buchan1; Ben Bridgewater1,2
1Northwest Institute of BioHealth Informatics, Manchester University2Department of Cardiothoracic Surgery, University Hospital of South Manchester3Department of Mathematical Sciences, Durham University
Background
• Around 35,000 adult cardiac surgery procedures performed each year in UK
• Mortality rate in 2010-11 was 3.4%• Monitoring primarily focuses on in-hospital
mortality
Cardiac surgery performance in the spotlight
BMJ 2005; 330 doi: 10.1136/bmj.330.7490.506 (Published 3 March 2005)Cite this as: BMJ 2005;330:506
Today’s monitoring programme
• National and local-level audits • Revalidation• Dr. Foster Health• FOI requests
The framework
Cardiac surgery Input data locally Uploaded periodically to central database
Aim: 3 monthsReality: 1 year
Statistician + cliniciansCQC website National audit
Aim: <1 yearReality: 3 years
Risk adjustment• Not all surgeons do the same caseload
• NHS surgeon• Does emergency surgery• Specialism in mitral valve
• Some possible solutions:– do nothing– develop a new model every x-years– a moving window recalibration or re-fit – dynamic generalized linear modelling (DGLM)
DGLMM
odel
coe
ffici
ents
(log
-odd
s)
Re-fit Piecewise re-fit
DGLM
• The largest change is coming from intercept
• Latent variables affecting risk?
• Doing nothing is not an option
• Acting periodically might be to late
Intercept
Re-fitPiecewise re-fit
Coeffi
cien
t
Online toolsN
ation
al A
udits
Mon
itorin
g To
ols
Dat
abas
e Q
uery
ing
e-lab
Summary
• Current infrastructure incompatible with developments in healthcare monitoring & surveillance
• Real-world data is not perfect which increases uncertainty + potentially a source of bias
• Modelling for contemporary cardiac surgery needs to adapt to changing dynamics
This research was partly funded by Heart Research UK (Grant number RG2583)