title: Use of a heart team in decision-making for patients with complex coronary disease at hospitals in Michigan prior to guideline endorsement.
abstract: BACKGROUND
  Revascularization decisions can profoundly impact patient survival, quality of life, and procedural risk. Although use of Heart Teams to make revascularization decisions is growing, data on their implementation in the real-world are limited. Our objective was to assess the prevalence of Heart Teams and their association with collaboration in routine practice.
  
  
  METHODS
  A survey of cardiologists and cardiac surgeons at 31 hospitals in Michigan was performed in May, 2011--prior to the recommendation for using Heart Teams in national guidelines. This survey included all percutaneous coronary intervention-performing hospitals in Michigan participating in the Blue Cross/Blue Shield of Michigan Cardiovascular Consortium and Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. It targeted both the use of Heart Teams and multidisciplinary Case Conferences.
  
  
  RESULTS
  There were 53 physician survey respondents from 27 hospitals with 4 hospitals not responding. Among respondents, 11 (40.7%) hospitals reported no Heart Teams or Case Conferences while 7 (25.9%) hospitals reported either a Heart Team or Case Conference. However, there was disagreement about the presence of a Heart Team at seven hospitals, and about Case Conferences at nine hospitals. Hospitals with definite Heart Teams reported significantly greater levels of collaboration between cardiologists and cardiac surgeons.
  
  
  CONCLUSIONS
  The overall presence of Heart Teams prior to their recommendation in national guidelines was limited. Even among hospitals with a potential Heart Team, there was substantial disagreement between respondents about their presence. Further refinement of the definition of a Heart Team and measures of successful implementation are needed.
authors.affiliation: Massachusetts General Hospital, Edward P. Lawrence Center for Quality and Safety, Boston, MA, United States of America.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Bruckel
authors.affiliation: University of Michigan Health System, Division of Cardiovascular Medicine, Ann Arbor, MI, United States of America, Blue Cross Blue Shield of Michigan Cardiovascular Consortium, Ann Arbor, MI, United States of America, University of Michigan Health System, Ann Arbor, MI, United States of America.
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
authors.affiliation: Blue Cross Blue Shield of Michigan Cardiovascular Consortium, Ann Arbor, MI, United States of America.
authors.forename: Milan
authors.initials: M
authors.lastname: Seth
authors.affiliation: University of Michigan Health System,Department of Cardiac Surgery, Ann Arbor, MI, United States of America, Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, United States of America.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Prager
authors.affiliation: Blue Cross Blue Shield of Michigan Cardiovascular Consortium, Ann Arbor, MI, United States of America.
authors.forename: Andrea
authors.initials: A
authors.lastname: Jensen
authors.affiliation: University of Michigan Health System, Division of Cardiovascular Medicine, Ann Arbor, MI, United States of America, Ann Arbor VA Center for Clinical Management and Research, Ann Arbor, MI, United States of America.
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
mesh_terms: D000704:Analysis of Variance; D054598:Blue Cross Blue Shield Insurance Plans; D003327:Coronary Disease / Q000601:surgery*; D003625:Data Collection / Q000379:methods / Q000706:statistics & numerical data; D003657:Decision Making; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008824:Michigan; D010348:Patient Care Team; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010820:Physicians / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D013903:Thoracic Surgery / Q000458:organization & administration / Q000706:statistics & numerical data