As the healthcare community strives to become more transparent as a means to improve care, some have turned to cardiac surgery quality assessments or physician report cards. However, others turn their noses up to these types of public report cards, saying that the information may not always be 100 percent accurate.
Publicly reporting hospitals’ performance has become all the rage. Today, Thompson Reuters, Leapfrog, U.S. News & World Report and others have begun releasing reports of the Top 100 hospitals and other lists, acting as the consumer reports of cardiac hospitals and the like.
Two separate viewpoints published in the June 19/26 issue of the Journal of the American College of Cardiology went back and forth on the pros and cons of these cardiac surgery report cards and questioned whether it should be a cardiologist’s duty to refer patients to cardiac surgeons with the best outcomes and lowest mortality rates.
First, Brown et al argued that cardiologists should make these public data known to patients, especially when referring patients to cardiac surgeons. Brown et al went as far as to say that it was cardiologists’ “ethical obligation” to sit down with patients and identify the cardiac surgeons with the lowest mortality rates and best outcomes.
While Brown and colleagues said that they recognized that their view may be controversial, they said that it is not in the best interest of the patient to withhold these data. In addition, they said that “it is the cardiologists’ duty to protect the welfare of the patient and refer him or her to the surgeon with the best outcomes.”
However, Shahian and Normand fired back, saying that Brown et al’s argument could use a more objective, evidence-based approach. The editorialists questioned how Brown et al defined “best possible outcomes” and said that they disagreed that it should be cardiologists' duty to refer patients to the “best” cardiac surgeon, which was defined by Brown et al as having the lowest risk-adjusted mortality rate.
A 2001 study found that these types of quality-driven report cards can markedly improve care; however, many say that the data remain unclear. While Shahian et al said that the data from the reports seemed to lead to a reduction in mortality, they said they were still unsure whether this was due to public dissemination (Ann Thorac Surg 2001;72:2155-2168).
How do you refer your patients? Do you use clinical data or stick to what you know and refer patients to someone working in your same facility? I would love to hear your thoughts.
Cardiovascular Business, associate editor