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European Journal of Cardio-Thoracic Surgery, Vol 9, 433-439, Copyright © 1995 by European Association for Cardio-thoracic Surgery
F Roques, F Gabrielle, P Michel, C De Vincentiis, M David and E Baudet
A prospective study was carried out from January to April 1993 in 42
centers to assess the quality of care in adult heart surgery in France. One
hundred eight parameters were collected (i.e., risk factors, surgery,
postoperative course) for 7181 patients. Eight simple, objective factors
were selected using a multivariate analysis. Point weighting was assigned
to each factor. A simple cumulative score was thereby established to
classify patients within four incremental risk groups (respective
distribution of patients and mortality were 38.6%, 26.5%, 21.3%, 13.5% and
2%, 3.9%, 6.1%, 21.4%). This score was highly predictive for mortality and
severe morbidity. Objectivity and independence of the observer, coupled
with a reliable score, are needed for meaningful assessment of the quality
of care. Administrative supervision and/or comparison of raw center results
therefore remain controversial. A national data base was developed as a
part of this study, that includes anonymous information from two-thirds of
all cardiac surgery cases. Nation-wide results for France allow each center
freely to assess its results. This self-assessment approach is, in our
view, the most accurate way of quality of care assessment. A pan- European
system using a similar approach should be developed.
ARTICLES
Quality of care in adult heart surgery: proposal for a self-assessment approach based on a French multicenter study
Cardiac Surgery Risk-Assessment Study Group, Hopital du Haut-Leveque, Bordeaux, France.
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