Founded in 1996, CASTS has served as a professional society for cardiothoracic surgeons in California. The Board of Directors and staff have promoted communications by hosting meetings and other activities. The California Healthcare Foundation awarded CASTS a grant in 2003, the California Cardiac Surgery Initiative (CCSI), in partnership with the California chapter of the American College of Cardiology to enhance the effectiveness of the mandatory reporting law, SB-680. Phase I of the project (2003-2005) focused on assisting providers in complying with data collection requirements and developing infrastructure for reporting outcomes and evaluating processes of care.

 

Phase II expanded the project to include all cardiac surgery procedures and interventional cardiology, now known as the California Cardiac Surgery and Intervention Project (CCSIP). Additional support from the Blue of Shield of California Foundation facilitated CASTS’ effort to publish outcomes from the OSHPD patient Discharge Dataset on its website, develop a regional STS report for members, and conduct site visits and information exchanges on best [practices for quality improvement. CA STS has contributed expertise for the CCORP Clinical Advisory Panel and technical support to OSHPD for the startup of the public reporting program. CA STS has engaged in outreach with surgeons, CCORP staff, information technology vendors, and hospital clinical data managers. The latter have attended workshops on enhancing data integrity through training and cross-hospital dialogue.

 

Jeffrey C. Milliken, MD, Chief, Division of Cardiothoracic Surgery, U.C. Irvine Medical Center, served as president of CA STS from 2009 through 2014. During this time the CCSIP, under the management of Beate Danielsen PhD, developed a sophisticated website reporting 30- and 90-day outcomes of all CABG, Valve, and PCI procedures. Dr. Junaid Khan, CA STS President succeeding Dr. Milliken, presided over negotiations with Medicare and updates to Title 22 and the CCSIP program. Subsequently, William Bommer MD, co-PI of the project, initiated a confidential program to report outlier status to heart hospitals, presenting encouraging results at national meetings of the ACC. The incoming CA STS president is Peyman Benharash MD of UCLA. He is currently helping to develop a statewide collaborative together with representative of OSHPD and California members of the American College of Cardiology.

Edwin Fonner, Jr., DrPH served as Executive Director for several years until his untimely death in 2014. During his tenure CASTS received support from the Blue Shield of California Foundation. Dr. Fonner achieved out reach with national groups, and developed close relationships with STS National Database and the Data Manager groups. He organized many successful statewide meetings such as pictured above.

 

Dr. Fonner emphasized lofty aspirations for the CA STS which he listed as follows:

Communications – CA STS will improve the frequency and quality of inter-disciplinary communications among data managers, clinical staff, and surgeons, Headway is being made with data managers and hospital staff. CA STS will attempt to improve rapport between the cardiac surgical community, CCORP, medical societies, payers, and the media.

Best practices and baseline data – CA STS will increase opportunities for sharing information on care processes that improve patient outcomes. Specific protocols and evidence-based guidelines will be posted on the web site and discussed at CA STS meetings. Better baseline data will be available for measuring improved processes and outcomes.

Cost effectiveness – Cost savings should emerge with opportunities to improve post-operative outcomes. Favorable returns on investment can be earned by pursuing initiatives like reducing blood use with adherences to new JCHAO guidelines on blood management.

Collaboration – Participants in CA STS workshops, web forums, and conference calls will share information on improving patient care and data integrity. Opportunities for surgeons to exchange ideas via web forums and conference calls will strengthen voice and promote cooperation.

Health information technology – Available tools and comparative data should improve decision-making CASTS will provide outcomes data from STS and administrative sources with web-based dashboards. Online forums a clinical data abstraction tool and idea exchanges will improve learning. The comparability of data for public reporting will accrue from collaboration by data mangers and CCORP.

Improved Health Literacy – A patient education module if effectively disseminated, will inform patients, family, and care givers about relative risks and benefits of treatment alternatives. It will be a breakthrough if CASTS is able to create a communications bridge between surgeons, cardiologists, and primary care focusing on appropriateness of CABG versus stent.