Using Information From Databases to Improve Clinical Practice: Lessons Learned Under Fire

Background. Information derived from a clinical database can be used to produce reports with valid, applicable data, to assemble outcomes data for purposes of marketing or practice survival, and to improve and optimize patient care. Methods. In response to lay-press figures suggesting a high risk-adjusted mortality at St. Peter’s Hospital (Albany, NY), a multidisciplinary group at the hospital undertook a collaborative review of information from our clinical database to identify any patterns that could explain this disturbing summary statistic. Results. This review showed that for the vast majority (>95%) of cases mortality was on a par with or lower than the statewide average. The elevated mortality was confined to a small and specific subset of high-risk patients. Once identified, attention was focused on this group of patients, and both cardiologists and surgeons discussed practice changes based on information from the clinical database. Since program changes were instituted in 1993, mortality has decreased in both high-risk and all other patients. Overall mortality for coronary artery bypass graft patients has decreased from 4.5% to about 1.5%. Conclusions. Use of a database to extract a single number reflecting patient-care performance, eg, short-term mortality, can conceal more information than it conveys. Only in-depth analysis of the information in the database can identify areas for improvement in clinical practice.