1. Prospective Analysis of Clinical Outcome: Influence on Surgical Professional Development Professor MJ Underwood Division of Cardiothoracic Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong

2. Questions What is Professional Development ? How does it relate to Clinical Outcomes ? How does it relate to a National Database?

3. Personal Viewpoint UK System Hong Kong Initiatives

4. Continuing Professional Development (CPD)

6. Interrelates – Clinical – Managerial – Professional PROVISION OF HIGH-QUALITY PATIENT CARE

7. Interrelates – Clinical – Managerial – Professional PROVISION OF HIGH-QUALITY PATIENT CARE

8. General Medical Council Guidance - 2006

9. High Quality Patient Care = Quality Assurance Programme in Cardiac Surgery AIM : Provide ‘safest’ journey for the patient during their hospital stay with ‘acceptable’ outcome defined by international standards.

10. Quality Assurance Components

11. ESSENTIAL: Quality Assurance Components Practical Factors Local Data Collection – Internal/External Validation National Data Collection – Internal/External Validation – Data Confidentiality/Safeguards International Data Comparison – Calibration, Comparison Personal/Surgical Factors Commitment Culture Consistent

12. CPD=High Quality Care=Quality Assurance=Data Collection =Data Analysis How do we collect data ? How do we analyze data ?

13. DATA COLLECTION: Surgical Perspectives Accurate Validated – Internal/External Available for Analysis – ‘real-time’ for risk monitoring Internationally Compatible Security

14. Data Collection: Summary ‘Validated’

15. Influencing Events 1994-96 Senior Registrar Bristol Royal Infirmary 1997 Fontan Scholarship Brussels 1999-2002 Consultant/Senior Lecturer Bristol Heart Institute 1995 External Review 1998 GMC Enquiry 2001 Public Enquiry

16. Senior Lecturer/Consultant (1999- On) – Audit Lead Cardiac Services – Clinical Governance Lead – R and D Quality Assurance Lead Consolidating Data Collection and Reporting Contribution to CEPOD Public Presentation of Results External Validation of BRI Data Collection Development of Sub- Specialist Databases

17. Saturday 27 June 1998 BMJ All changed, changed utterly British medicine will be transformed by the Bristol case Richard smith, Editor

21. Continuous Professional Development: Institutional Reporting

23. Continuous Professional Development: Individual Reporting

24. Prospective Analysis of Clinical Outcome: Where are we in Hong Kong ? Institution of Computerized Data Collection and Analysis System – Automated demographic data Data Input at ‘point of clinical care’ Dedicated Database Manager – Accuracy, validation processes

25. Automated Demographics and Risk Calculation

26. Direct Comparison of Risk Scoring Systems: Testing Receiver Operating Characteristic (ROC) Curves – Area represents probability that risk predictor accurately discriminates between death and survival – Area of 1 = Perfect – Closer to 1 better, Closer to 0.5 less accurate Calibration Plots – Plot observed vs expected events in calibration plot – Chi-squared value used as measure of accuracy of matching

27. Risk-Scoring in the UK Population

28. Validation of Euroscore in Hong Kong ROC Area 0.819: modified Euroscore ROC Area 0.823: logistic Euroscore

29. Influence of Risk-Stratified Data Analysis on Professional Development. Monitor actual mortality and morbidity vs predicted – Essential for Quality Assurance Progamme Compare with International Data

30. Comparison of Risk-Profiles: East vs West ! But: – Does risk-validation hold for sub-groups ? – Is there a need for ‘population specific’ risk assessment

31. Hong Kong Cardiac Database: Overview

32. A National Database :Unique Practical Challenges from a Surgeon Differing data collection mechanisms – How merge ? Accuracy and validity – What infrastructure ? Security – Who see’s the data ? Data Analysis – Who analyses the data? Presentation and Publication – Who ?

33. Hong Kong Cardiac Database: Overview Chinese Cardiac Surgical Database

34. Professional Development/Clinical Outcome/National Database: Summary Inter-related – inseparable Inevitable – ‘consumer’/provider driven Irreversible – USA, UK, Europe

35. Editor's choice Individual performance data: revelation and revolution Welcome to a new world. Be brave. Kamran Abbasi, acting editor BMJ 2005;330: (5 March)