Quality control and performance improvement in the US health care system are based on several pillars: external review is performed by either government agencies, insurance companies, or public media. In cardiac surgery the STS database forms the backbone of most of these reviews. Internal review is based on providing outcome data, establishing benchmarks for performance, and root-cause analysis of adverse events. Peer review is used to analyze major issues in providing care. Transparency of the process and of outcome numbers generated is key for the success of measurements to improve performance. Finally, education of all health care providers in the hospital is needed to provide quality care and good outcomes. Maintaining proficiency of physicians and hospital personal in pathways and procedures requires constant educational efforts and clear pathways and guidelines. Growing resources have to be dedicated to quality management. As outcome data become essential in obtaining insurance contracts and government certification the investing into a comprehensive quality assurance program will pay off.
Georg Thieme Verlag KG Stuttgart, New York.