title: First results of a national initiative to enable quality improvement of cardiovascular care by transparently reporting on patient-relevant outcomes.
abstract: OBJECTIVE
  The aims of this study were to assess patient-relevant outcomes of delivered cardiovascular care by focusing on disease management as determined by a multidisciplinary Heart Team, to establish and share best practices by comparing outcomes and to embed value-based decision-making to improve quality and efficiency in Dutch heart centres.
  
  
  METHODS
  In 2014, 12 Dutch heart centres pooled patient-relevant outcome data, which resulted in transparent publication of the outcomes, including long-term follow-up up to 5 years, of approximately 86 000 heart patients. This study presents the results of both disease- and treatment patient-relevant outcome measures for coronary artery disease and aortic valve disease. The patients included were presented to a Heart Team and underwent invasive or operative treatment. In-hospital and out-of-hospital patient-relevant outcome measures were collected as well as initial conditions. Quality of life was assessed using the Short Form (SF)-36 or SF-12 health survey.
  
  
  RESULTS
  In the Netherlands, patient-relevant and risk-adjusted outcomes of cardiovascular care in participating heart centres are published annually. Data were sufficiently reliable to enable comparisons and to subtract best practices. The statistically lower risk-adjusted mortality rate after coronary artery bypass grafting resulted in a voluntary roll-out of a perioperative safety check. The in-depth analysis of outcomes after percutaneous coronary intervention resulted in process improvements in several heart centres, such as pre-hydration for patients with renal insufficiency and the need of target vessel revascularizations within a year.
  
  
  CONCLUSIONS
  Annual data collection on follow-up of patient-relevant outcomes of cardiovascular care, initiated and organized by physicians, appears feasible. Transparent publication of outcomes drives the improvement of quality within heart centres. The system of using a limited set of patient-relevant outcome measures enables reliable comparisons and exposes the quality of decision-making and the operational process. Transparent communication on outcomes is feasible, safe and cost-effective, and stimulates professional decision-making and disease management.
authors.affiliation: AMC Heart Center, Department of Cardio-Thoracic Surgery, Academic Medical Center at the University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Dennis
authors.initials: D
authors.lastname: van Veghel
authors.affiliation: AMC Heart Center, Department of Cardio-Thoracic Surgery, Academic Medical Center at the University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Marloes
authors.initials: M
authors.lastname: Marteijn
authors.affiliation: AMC Heart Center, Department of Cardio-Thoracic Surgery, Academic Medical Center at the University of Amsterdam, Amsterdam, Netherlands b.a.demol@amc.uva.nl.
authors.forename: Bas
authors.initials: B
authors.lastname: de Mol
mesh_terms: D001021:Aortic Valve; D019985:Benchmarking / Q000379:methods; D002300:Cardiac Care Facilities / Q000458:organization & administration / Q000592:standards*; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D019468:Disease Management; D005500:Follow-Up Studies; D006302:Health Services Research / Q000379:methods; D006349:Heart Valve Diseases / Q000401:mortality / Q000628:therapy*; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D010359:Patient Readmission / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000458:organization & administration*; D011788:Quality of Life; D012008:Recurrence; D016896:Treatment Outcome
keywords: Cardiovascular; Outcomes; Patient-relevant; Quality improvement; Transparency; Value-based healthcare