The processes, structures, and outcomes of care in cardiac surgery study: An overview

The purpose of this article is to summarize the following set of 10 manuscripts on the Processes, Structures, and Outcomes of Care in Cardiac Surgery (PSOCS) study. The authors believe that many of the innovative study design and implementation features of PSOCS will be of interest to clinicians and to the health services research community. This series of articles represents an extensive review of the existing literature and provides an overview of the study’s key design and analytic features as well as preliminary information on the psychometric properties of some of the data collection instruments. The preliminary findings on the processes and structures of cardiac surgical care demonstrate the wide variations between centers observed across the six initial participating facilities. This observed variation is critical in enabling the testing of the study’s hypotheses at the hospital level of analysis. To avoid potentially erroneous conclusions from being drawn on this small “training” data set, however, the authors did not link these findings with patient outcomes. This final analytic step, to link processes and structures of care with risk-adjusted outcomes, remains the ultimate objective of this study.