Physician Outlier Review Protocol

Mass-DAC does not publically report the results of the risk adjustment models for cardiac surgeons or PCI operators.  Findings from these analyses are reviewed by a sub-committee of surgeons for the cardiac surgery cohort and a sub-committee of interventionalists for the PCI cohort.  The sub-committee, of no fewer than 5 members, is selected by the MA-STS and MA-ACC Physician Oversight Committees and must meet all of the requirements listed in the protocols.  The sub-committee reviews all outliers, referring to a surgeon or an operator having statistically higher or lower than expected mortality.

Mass-DAC identifies four potential categories of physicians on the basis of risk-standardized 30-day all-cause mortality rates for cardiac surgery and in-hospital all-cause mortality rates for PCI. These groups are:

  • Silver – physicians having lower than expected mortality (95% SMIR interval lies entirely below the crude state 3-year overall mortality rate).
  • Green – physicians having mortality no different than expected (95% SMIR interval estimate contains the 3-year overall mortality rate and the lower bound of the 90% SMIR interval estimate is at or below the crude state 3-year overall mortality rate).
    • Yellow – physicians approaching red outlier status but not yet statistically higher than expected (95% SMIR interval estimate contains the 3-year overall mortality rate and if the lower bound of the 90% SMIR interval estimate lies entirely above the 3-year overall mortality rate).
  • Red – physicians having higher than the expected mortality (95% SMIR interval lies entirely above the crude state 3-year overall mortality rate).

Any operator identified in the “Red” category will undergo further review by the sub-committee. This shall involve review of all available Mass-DAC clinical records relating to the in-hospital deaths attributed to the identified operators. These records shall include, but are not limited to, the admission, procedure and discharge notes related to the admission of interest.

The full protocol for each review sub-committee are available below in a portable document format.