Public release of cardiac surgery outcomes data in New York: What do New York state cardiologists think of it?

doi:10.1016/S0002-8703(97)70106-6

American Heart Journal

Volume 134, Issue 1, July 1997, Pages 55-61

https://doi.org/10.1016/S0002-8703(97)70106-6 Get rights and content

Abstract

Correction: In the July 1997 issue of the American Heart Journal, the following article was published with some text and a table omitted. The article is therefore being republished in its entirety.

Background and Objective: Since 1990, risk-adjusted outcomes for patients undergoing coronary artery bypass graft surgery in New York state have been released to the public. The purpose of this study was to assess the extent to which referring cardiologists share these data with patients and use these data to make referrals. Methods: A survey questionnaire was sent to all cardiologists in New York in the New York State Chapter of the American College of Cardiology. Results: Four hundred fifty cardiologists responded to the survey. Most (94%) found the report “easy to read.” A majority (67%) found the report to be “very accurate” or “somewhat accurate” in capturing differences in the performance of cardiac surgeons, whereas 33% found it to be “not at all accurate.” Twenty-two percent reported that they “routinely discuss the reports with their patients,” and 38% responded that the information has affected their referrals to surgeons “very much” or “somewhat.” Conclusions: A majority of cardiologists has not generally changed their well-established referral patterns as a result of the New York coronary artery bypass graft surgery reports. However, there has been a modest impact on referrals resulting from the distribution of these reports. The findings also suggest that increased dialogue between clinicians and policy makers regarding the format and structure of public releases would be a valuable undertaking. (Am Heart J 1997:134:1120-8.)

Section snippets

Survey of cardiologists

Because patients undergoing CABG are typically referred for surgery by a cardiologist, addresses for cardiologists were obtained from the New York State Chapter of the American College of Cardiology. A postage-paid return envelope was included in the mailing, and responders were asked to send their responses to the State University of New York at Albany School of Public Health.

Questions were related to the comprehensibility and accuracy of the reports and the extent to which cardiologists share

Results

A total of 450 cardiologists (36% of the 1267 listed in the State Educations Department's Physician Master File as specializing in cardiology) returned questionnaires. As indicated in Table I, cardiologists responded that the material in the reports was not difficult to comprehend. A total of 94% of respondents found the report “easy to read”; 74% said the report was “not at all” too technical, and approximately 75% of the respondents did not judge the number of charts or graphs to be too

Background

Since 1990, the New York State Department of Health has been issuing annual reports for CABG surgery that provide assessments of hospital performance. Recent reports contain, for each of the hospitals in New York in which the procedure is performed, the number of cases, number of deaths, observed mortality rate, expected mortality rate, risk-adjusted mortality rate, and a confidence interval for the risk-adjusted mortality rate. They also contain the same information for all surgeons who have

Acknowledgements

We thank Kenneth Shine, MD, for commenting on this paper and James Jollis, MD, Eric Peterson, MD, and Patrick Romano, MD, for their help in framing the survey questions.

References (18)

EL Hannan et al.
New York state’s cardiac surgery reporting system: four years later
Ann Thorac Surg
(1994)
SW Dziuban et al.
How a New York cardiac surgery program uses outcomes data
Ann Thorac Surg
(1994)
New York State Department of Health
Coronary artery bypass surgery in New York state: 1991-1993
(June 1995)
New York State Department of Health
Coronary artery bypass ):surgery in New York state: 1992-1994
(November 1996)
EL Hannan et al.
Adult open heart surgery in New York state: an analysis of risk factors and hospital mortality rates
JAMA
(1990)
EL Hannan et al.
Improving the outcomes of coronary artery bypass surgery in New York state
JAMA
(1994)
MR Chassin et al.
Benefits and hazards of reporting medical outcomes publicly
N Engl J Med
(1996)
LK Altman
Heart surgery death rates decline in New York
The New York Times
(1990 Dec)
D Zinman
Heart surgeons rated. State reveals patient mortality records
Newsday
(1991 Dec)

There are more references available in the full text version of this article.

Cited by (51)

Comment on: Patient perspectives on surgeon-specific outcome reports in bariatric surgery
2022, Surgery for Obesity and Related Diseases
Patient perspectives on surgeon-specific outcome reports in bariatric surgery
2022, Surgery for Obesity and Related Diseases
Surgeon specific outcome reports (SSOR) in the UK can be accessed freely by the general public to promote transparency and informed decision-making. However, the views amongst bariatric patients concerning these data are unknown.
The aims of this study were to determine patient awareness, views and priorities for outcome reporting in bariatric surgery, and to provide recommendations for future surgeon-specific outcome reporting through the United Kingdom National Bariatric Surgery Registry.
Bariatric surgical unit in a UK university teaching hospital.
We adapted a previously validated questionnaire and surveyed the views of 150 patients in a single bariatric surgical unit. We collected data concerning awareness, views, and future priorities for outcome reporting.
A full 73% of participants were unaware they could access SSOR. Of the participants that were unaware, 75% stated that they would have accessed SSOR had they been aware they could. Of the participants that had previously accessed SSOR, 86% stated they understood the data, although 61% indicated it did not influence their choice of surgeon. The majority of participants favored public release of outcome reports at the surgeon-level (75%) and hospital-level (83%). The 3 main priorities indicated by participants for future outcome reporting were complication rates (91%), patient reported outcome measures (90%), and reoperation rate (89%), all at the surgeon level.
Patient awareness of outcome reporting is poor. Efforts must be made to increase awareness of SSOR. Patients should be incorporated as key stakeholders in determining future outcome reporting in bariatric surgery.
Risk Aversion and Public Reporting. Part 1: Observations From Cardiac Surgery and Interventional Cardiology
2017, Annals of Thoracic Surgery
Citation Excerpt :
Despite 94% of cardiologists being aware of report cards, 71% said they had not discussed them with any patients, only 25% said report cards had moderate (21%) or substantial (4%) effect on referrals, and 75% said there was minimal or no effect on referrals. These results were quite similar to the earlier findings of Hannan and colleagues [41]. Burack and colleagues [29] surveyed New York cardiac surgeons and found that they were more likely to deny an operation to high-risk CABG patients than to comparably high-risk aortic dissection patients because outcomes for the latter are not publicly reported.
Risk aversion is a potential unintended consequence of health care public reporting. In Part 1 of this review, four possible consequences of this phenomenon are discussed, including the denial of interventions to some high-risk patients, stifling of innovation, appropriate avoidance of futile interventions, and better matching of high-risk patients to more capable providers. We also summarize relevant observational clinical reports and survey results from cardiovascular medicine and surgery, the two specialties from which almost all risk aversion observations have been derived. Although these demonstrate that risk aversion does occur, the empirical data are much more consistent and compelling for interventional cardiology than for cardiac surgery.
Quality Reporting and Demand
2014, Encyclopedia of Health Economics
This article reviews the economics of quality reporting and demand in the market for health care providers. A simple conceptual framework demonstrates both the positive and normative impact of quality reporting in the market. The role for uncertainty and insurance is then considered; two issues that further complicate patient choice in this market. The author then reviews some key conceptual and empirical conclusions on the impact of quality reporting on demand in the market for primary care physicians and specialists. In the case of the former, quality reporting is very challenging given the complexity of the job, jointness in production between patients and doctors, and the lack of agency in making choices. Subsequently, quality reporting seems unlikely to enhance welfare and, in some cases, such as web-based reporting on patient satisfaction, could distort incentives. The discussion of specialist choice focuses on the experience in the market for bypass surgery. Evidence suggests quality report cards have impacted demand significantly in the market. Generally the response is concentrated among a small share of patients and the response is convex in quality. There is also evidence that much of the change in quality has come from the response of the surgeons and hospitals supplying care, potentially through selection against sicker patients as well as through intrinsic motivation to improve. Finally, the results of quality reporting efforts in health care provider markets are compared to the experience in education. The market failures due to missing markets for information are similar in both markets as are the impacts of quality information on demand.
Cardiac surgeon report cards, referral for cardiac surgery, and the ethical responsibilities of cardiologists
2012, Journal of the American College of Cardiology
Citation Excerpt :
Despite the increasingly widespread availability of cardiac surgeon report cards, available evidence, in the form of surveys of New York and Pennsylvania cardiologists and a market share analysis of New York State cardiac surgery programs, suggests that cardiologists do not use the cardiac surgery report cards when referring their patients for cardiac surgery. Hannan et al. (19) surveyed New York State cardiologists in 1997 regarding their impressions and use of the publicly reported New York State cardiac surgery outcomes data. Although cardiologists found the reports easy to read and understand, 78% of cardiologists did not discuss the reports with patients before making referrals to surgeons.
Public reporting of clinical outcomes data is but one response to calls for increasing transparency in health care. Cardiac surgical operations are among the most commonly performed complex operative procedures. Risk-adjusted cardiac surgery mortality rate data for individual cardiac surgeons are currently available for >25% of the U.S. population as well as for Great Britain and Ireland. Although cardiologists are the primary source of referral of patients for cardiac surgery, surveys of cardiologists and analysis of market share data indicate this information is not being used to refer to cardiac surgeons with the lowest mortality rates. We review the ethical principles that should obligate cardiologists to discuss and use outcomes data, when available, in selecting cardiac surgeons to whom they refer their patients.
2011 ACCF/AHA guideline for coronary artery bypass graft surgery
2011, Journal of the American College of Cardiology
Citation Excerpt :
To address the need for valid and reliable risk-adjusted outcomes data, cardiac surgery registries were developed by the STS (306,725,727), Veterans Administration (306,736–738), Northern New England Cardiovascular Disease Study Group (739,740), and the state of New York (741,742). These have been the basis for several performance assessment and improvement strategies, including public report cards (742–744), confidential feedback to participants showing their performance relative to national benchmarks (306,737,745–748), and state or regional collaboratives that identify and disseminate best-practices information (749). Public report cards are the most controversial of these 3 approaches.

View all citing articles on Scopus

^☆: From the ^aDepartment of Health Policy and Management, School of Public Health, State University of New York at Albany, ^bAlbany Medical College, and ^cNew York State Department of Health.

^☆☆: Supported in part by Grant No. HS 06503 from the Agency for Health Care Policy and Research of the U.S. Department of Health and Human Services.

^★: Reprint requests: Edward L. Hannan, PhD, Department of Health Policy and Management, SUNY Albany School of Public Health, One University Place, Rensselaer, NY 12144-3456.

^★★: 4/1/82103

View full text

Public release of cardiac surgery outcomes data in New York: What do New York state cardiologists think of it?☆,☆☆,★,★★

Abstract

Section snippets

Survey of cardiologists

Results

Background

Acknowledgements

Ann Thorac Surg

Ann Thorac Surg

Coronary artery bypass surgery in New York state: 1991-1993

Coronary artery bypass ):surgery in New York state: 1992-1994

Adult open heart surgery in New York state: an analysis of risk factors and hospital mortality rates

JAMA

Improving the outcomes of coronary artery bypass surgery in New York state

JAMA

Benefits and hazards of reporting medical outcomes publicly

N Engl J Med

Heart surgery death rates decline in New York

The New York Times

Heart surgeons rated. State reveals patient mortality records

Newsday