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J Thorac Cardiovasc Surg 2006;132:8-9
© 2006 The American Association for Thoracic Surgery

Editorial

The "scientific investment" by cardiac surgery

Eastern Carolina Cardiovascular Institute, Professor and Associate Chief, Division of CT and Vascular Surgery, Director of Quality and Clinical Effectiveness, Department of Surgery, Brody School of Medicine at ECU, Greenville, NC

Received for publication February 14, 2006; accepted for publication March 13, 2006.

^_* Address for reprints: T. Bruce Ferguson Jr, MD, Professor, Division of CT and Vascular Surgery, Brody School of Medicine at ECU, 600 Moye Blvd, Greenville, ND 27834. (Email: Tbruceferg732@pol.net).

The first 20% of the full text of this article appears below.

Before it is over, 2006 will be an interesting, and perhaps exciting, year in cardiothoracic surgery. On the one hand, after years of clinical and financial commitment to improving quality of care through scientific analysis of the practices undertaken in adult cardiac surgery, we as a specialty are poised to benefit if our clinical metrics for quality and performance evaluation are adopted. Alternatively, to meet the mandate of "applicability across all providers," we may be relegated to a few data metrics collected through administrative data mechanisms, effectively rendering these scientific efforts to the sidelines. ^E1

Both of these scenarios relate to the pay-for-performance (P4P) movement in medicine, which hits the ground running in 2006. ^E2 The issue at hand is not whether P4P in some form is going to happen, but rather whether the "scientific investment" of the past 15 years by cardiothoracic surgeons worldwide, and the results obtained, warrant consideration beyond "kudos" in this ongoing dynamic.

This "scientific investment" has been nothing short of remarkable, beginning with the efforts of the Northern New England Cardiovascular Study Group, the formation of the Veterans Administration and Society of Thoracic Surgeons National Databases, and the development of the Parsonnet risk-evaluation system. In Europe, similar national database efforts took place, and the EuroSCORE risk-evaluation system was developed and used widely across the continent. In the United States, voluntary provider-led regional efforts at quality evaluation commenced in the face of public reporting of regional outcomes of data from the New York State Registry. Numerous large local data systems have been developed and reported on as well. During the past 7 years the Society . . . [Full Text of this Article]

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