Report cards on cardiac surgeons: assessing New York State's approach
The so-called 'report cards' that rate physicians and hospitals based on death rates should be standardized across all hospitals and should be periodically evaluated. The New York State health department began the Cardiac Surgery Reporting System (CSRS) in 1989, which reported mortality rates at participating hospitals following coronary-artery bypass grafting (CABG). Analysis of the data reported to CSRS indicates that the system may need considerable refinement before it can be used to rate hospitals and physicians. Thirty-eight percent of the physicians would be ranked differently just by standardizing how the hospitals report mortality rates. When the health department revised the system in 1991, inconsistencies were created when early data was combined with later data. Analysis of the CSRS report cards revealed that surgical mortality rates dropped, but this may have resulted when surgeons refused to treat very ill patients because it would have affected their rank.
Publication Name: The New England Journal of Medicine
In search of America's best hospitals: the promise and reality of quality assessment
An annual report card on hospitals published in US News & World Report suffers from a lack of data on structure, process and outcome in US hospitals. Structure covers what care a hospital could provide and process measures what care is actually provided. Outcome measures how the patient benefits from that care. The authors of the report, 'America's Best Hospitals', use Medicare and other databases to collect some of this data, but other data comes from physician surveys. This is partly because there is a lack of data on many of these measures.
Publication Name: JAMA, The Journal of the American Medical Association
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