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 quarterly meetings and other activities. The CASTS has been supported by unrestricted grants from the California Healthcare Foundation, Blue Shield of California, and Unihealth Foundation. These grants have funded the California Cardiac Surgery and Intervention Project (CCSIP), a data collection and outcomes reporting program, in partnership with the California chapter of the American College of Cardiology. This project has served to enhance the effectiveness of the mandatory CABG reporting law, SB-680, by reporting on valve and percutaneous coronary interventions. In its initial phase, the CCSIP assisted providers in complying with data collection requirements and developing infrastructure for reporting outcomes and evaluating processes of care. The project now focuses on establishing collaboratives of heart team members to study and implement best practices. Informing stakeholders is an important overarching goal of the CCSIP as well as CASTS.
Support from healthcare foundations facilitated CASTS' efforts to publish outcomes from the OSHPD Patient Discharge Dataset on its web site, develop a regional STS report for members, and conduct site visits and information exchanges on best practices for quality improvement. CASTS has contributed expertise for the CCORP Clinical Advisory Panel and technical support to OSHPD for the startup of the public reporting program. CASTS has engaged in outreach efforts 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.
The CASTS achieved national prominence under the leadership of Ed Fonner DrPH, who guided the Society as Executive Director from 2008 through 2013. Ed's vision to create a national collaborative to share quality improvement goals was highlighted by a meeting at the STS national convention in January, 2013 in San Francisco. At this meeting, STS leaders and heart team members from around the country shared ideas and goals for implementation of regional performance improvement efforts. Unfortunately, soon after this meeting Ed became ill and had to resign from CASTS. Ed's efforts included a desire to flatten hierachy and bring all heart team members to the table in the sharing of ideas for improving patient care. He held regular workshops for nurses and data managers to discuss data quality and best practices. The picture above, in which Ed can be seen as the prominently tall individual in the back of the group, is from a data management workshop held in Sacremento in September 2008.
CASTS Initiatives 2008-2013:
Communications – CASTS provided of inter-disciplinary communications among data managers, clinical staff, and surgeons. Headway was made with data managers and hospital staff. CASTS improved rapport between the cardiac surgical community, CCORP, medical societies, payers, and the media.
Best practices and baseline data – CASTS increased opportunities for sharing information on care processes that improve patient outcomes. Specific protocols and evidence-based guidelines were discussed at CASTS meetings. Better baseline data was made 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 pursing initiatives like reducing blood use with adherence to new JCAHO guidelines on blood management. A workshop focusing on blood usage and prevention of postoperative complications was held in San Diego in January 2010.
Collaboration – Participants in CASTS workshops, web forums, and conference calls shared information on improving patient care and data integrity. Opportunities for surgeons to exchange ideas via web forums and conference calls have been implemented to strengthen voice and promote cooperation.
CASTS 2013 and Beyond:
Health information technology – Available tools and comparative data should improve decision-making. CASTS has worked to 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.
Legislative Affairs--There will continue to be bills and initiatives originating in Sacramento that require review and comment. The CASTS will continue to work with the California Chapter of the ACC to defend the interests of our heart programs by articulating a stand on policy matters.
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