Understanding Differences in Administrative and Audited Patient Data in Cardiac Surgery: Comparison of the University HealthSystem Consortium and Society of Thoracic Surgeons Databases.

BACKGROUND: The University HealthSystem Consortium (UHC) administrative database has been used increasingly as a quality indicator for hospitals and even individual surgeons. We aimed to determine the accuracy of cardiac surgical data in the administrative UHC database vs data in the clinical Society of Thoracic Surgeons database. STUDY DESIGN: We reviewed demographic and outcomes information of patients with aortic valve replacement (AVR), mitral valve replacement (MVR), and coronary artery bypass grafting (CABG) surgery between January 1, 2012, and December 31, 2013. Data collected in aggregate and compared across the databases included case volume, physician specialty coding, patient age and sex, comorbidities, mortality rate, and postoperative complications. RESULTS: In these 2 years, the UHC database recorded 1,270 AVRs, 355 MVRs, and 1,473 CABGs. The Society of Thoracic Surgeons database case volumes were less by 2% to 12% (1,219 AVRs; 316 MVRs; and 1,442 CABGs). Errors in physician specialty coding occurred in UHC data (AVR, 0.6%; MVR, 0.8%; and CABG, 0.7%). In matched patients from each database, demographic age and sex information was identical. Although definitions differed in the databases, percentages of patients with at least one comorbidity were similar. Hospital mortality rates were similar as well, but postoperative recorded complications differed greatly. CONCLUSIONS: In comparing the 2 databases, we found similarity in patient demographic information and percentage of patients with comorbidities. The small difference in volumes of each operation type and the larger disparity in postoperative complications between the databases were related to differences in data definition, data collection, and coding errors.

The mayo high performance teamwork scale: reliability and validity for evaluating key crew resource management skills.

PURPOSE: To develop and evaluate a participant rating scale for assessing high performance teamwork skills in simulation medicine settings. METHODS: In all, 107 participants in crisis resource management (CRM) training in a multidisciplinary medical simulation center generated 273 ratings of key CRM skills after participating in two or three simulation exercises. These data were analyzed using Rasch and traditional psychometric approaches to develop the 16-item Mayo High Performance Teamwork Scale (MHPTS). Sensitivity to change as a result CRM training was also evaluated. RESULTS: The MHPTS showed satisfactory internal consistency and construct validity by Rasch (person reliability = 0.77; person separation = 1.85; item reliability = 0.96; item separation = 5.04) and traditional psychometric (Cronbach's alpha = 0.85) indicators. The scale demonstrated sensitivity to change as a result of CRM training (pretraining mean = 21.44 versus first posttraining rating mean = 24.37; paired t = -4.15, P < 0.0001; first posttraining mean = 24.63 versus second posttraining mean = 26.83; paired t = -4.31 P < 0.0001). CONCLUSIONS: The MHPTS provides a brief, reliable, practical measure of CRM skills that can be used by participants in CRM training to reflect on and evaluate their performance as a team. Further evaluation of validity and appropriateness in other simulation and medical settings is desirable.