Saving Hearts: The University of Texas Cardiac Surgery Quality Consortium and UT-HIP

As the University of Texas System works to optimize quality outcomes within the system’s major medical schools, UT cardiac surgeons have come together to learn from one another and strive for excellence in cardiac surgical outcomes through the University of Texas Cardiac Surgery Quality Collaborative (UTCSQC). Given the size of the state of Texas, the breadth of the UT System and its medical schools throughout the state, as well as the system’s primary mission to serve our patients with the highest quality care, standardization and optimization of quality in cardiac surgery remains the highest priority of the quality collaborative within UT-HIP. 

To support this standardization the UTCSQC utilizes the Society of Thoracic Surgeons (STS) adult cardiac surgery database. The STS database has been operational for over 40 years and has standard risk models for the five major categories of cardiac surgery, isolated coronary artery bypass, aortic valve replacement, aortic valve replacement with coronary bypass, mitral valve repair and replacement and mitral valve repair replacement with coronary artery bypass. The STS database has provided standard risk adjusted historical quality data at the medical schools at The University of Texas Southwestern Medical Center, McGovern Medical School at UT Health, The University of Texas Health Science Center at San Antonio and The University of Texas Medical Branch allowing for an apples-to-apples comparison of individual cardiac surgeon and institutional performance. This provides an objective and reflective mirror of a cardiac surgery program's performance compared with other programs within the UT System, statewide and nationally. Of honorable mention in this regard, UT Southwestern cardiac surgery, under the leadership of Dr. Michael Jessen has been recognized by the STS as a three-star program in mitral valve surgery in the United States. This notable distinction indicates that the UT Southwestern cardiac surgery program is in the top 2.5% of cardiac programs in the United States performing mitral valve surgery. 

In addition to the STS database, UTCSQC also uses Vizient’s Clinical Database (CDB) and Quality and Accountability study, which has been widely recognized as the gold standard in assessing cardiac surgery quality, to measure additional quality indicators.   

Currently, the UTCSQC meets quarterly and is focused on decreasing 30-day cardiac surgery, mortality and additional quality improvement projects in cardiac surgery focused on blood transfusion rates, reoperation rates, postoperative time on ventilator and 30-day readmission rates. 

“What we have learned in our system is that each institution excels in one or two areas but lags behind in other areas that other UT medical schools do significantly better in,” said Dr. Roughneen. “This variability is quite fascinating and boils down to institutional variations in processes practiced by our surgeons that are quite specific from one UT institution to another. Identifying where an institution’s strengths and weaknesses exist and seeing how they match up with one another has been critical in our quest to improve mortality and patient outcomes. We simply want to identify, discuss and share best practices and processes throughout our institutions.”  

The development of this specialty specific collaborative across UT System institutions is the first of its kind and provides a template for other specialties to follow. The implications of the synergy between UT institutions can be powerful in the healthcare marketplace given the size of the UT System and the state of Texas. Utilizing this synergy has implications not only in its primary focus of standardizing and optimizing patient care to the highest level but also in terms of a collective approach towards healthcare insurance contracts and supply chain economies of scale. 

The UTCSQC was developed by Dr. Patrick Roughneen, Adjunct Professor of Cardiovascular and Thoracic Surgery at UT McGovern School of Medicine with the support of the office of the Vice Chancellor for Health Affairs Dr. John Zerwas, and university departmental chairmen of cardiovascular surgery Dr. Anthony Estrera, Dr. John Calhoon, Dr. Michael Jessen, Dr. Abe DeAnda and Dr. Igor Gregoric. The success of the quality collaborative has been made possible through a partnership with UT-HIP leadership Zain Kazmi, Dr. Robert Murphy, ShuRon Green and their team led by Ankita Podichetty and Gustavo Villarreal. UTCSQC expanded in 2023 to include non-academic private cardiac surgeons within the Memorial Hermann Health System in Houston. This landmark expansion was achieved through the vision and efforts of Dr. Anthony Chairman of the Department of Cardiovascular and Thoracic Surgery at UT McGovern School of Medicine. This unites many cardiac surgeons in Houston together toward improving quality and optimizing patient outcomes. It is soon anticipated that cardiac surgeons at The University of Texas at Austin Dell Medical School will soon be joining the collaborative once STS data sharing agreements are finalized. 

The development and work of UTCSQC was presented at the Society of Thoracic Surgeons 59th Annual Meeting in San Diego in 2023 highlighting the importance of inter-institutional collaboration and synergy in improving patient care outcomes in cardiac surgery. Additionally, UTCSQC has hosted Dr. Richard Prager, as honorary lecturer in recognition of his work in founding the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative in 2001. The collaborative has been so successful that Blue Cross Blue Shield of Michigan now partners with participating institutions providing for its funding and sharing cost savings past back to participating institutions. In the future, the UTCSQC would like to engage in cardiovascular research using the STS and Vizient CDB. The ongoing quality improvement projects may lead to research projects. Additionally, the group is interested in analyzing the practice patterns at the UT system and other high performing hospitals for the cardiac procedures we study, such as Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVR). 

“We greatly look forward to the future of this collaborative within our specialty of cardiac surgery within the University of Texas system add to what we can learn from working together both in our specialty and in others,” said Dr. Roughneen.