National and institutional quality initiatives provide benchmarks for evaluating the effectiveness of medical care. However, the dramatic growth in the number and type of medical and organizational quality-improvement standards creates a challenge to identify and understand those that most accurately determine quality in cardiac surgery. It is important that surgeons have knowledge and insight into valid, useful indicators for comparison and improvement. We therefore reviewed the medical literature and have identified improvement initiatives focused on cardiac surgery. We discuss the benefits and drawbacks of existing methodologies, such as comprehensive regional and national databases that aid self-evaluation and feedback, volume-based standards as structural indicators, process measurements arising from evidence-based research, and risk-adjusted outcomes. In addition, we discuss the potential of newer methods, such as patient-reported outcomes and composite measurements that combine data from multiple sources.

国家和机构的质量举措为评估医疗保健的有效性提供了基准。然而，医疗和组织质量改进标准的数量和类型的急剧增长给识别和理解最准确地确定心脏手术质量的标准带来了挑战。重要的是外科医生对有效、有用的指标具有知识和洞察力，以便进行比较和改进。因此，我们回顾了医学文献并确定了专注于心脏手术的改进措施。我们讨论了现有方法的优缺点，例如帮助自我评估和反馈的综合性区域和国家数据库、作为结构指标的基于数量的标准、基于证据的研究产生的过程测量、和风险调整后的结果。此外，我们还讨论了新方法的潜力，例如患者报告的结果和结合来自多个来源的数据的综合测量。