Benefits and hazards of reporting medical outcomes publicly

Article Abstract:

The analysis and publication of data on mortality from coronary-artery bypass grafting (CABG) at different New York hospitals and by different surgeons has led to improvements in surgical programs and patient outcome. In 1989 the New York State Department of Health created a registry of patients having CABG and published risk-adjusted mortality rates. When this data was published in a newspaper health care professionals were concerned that the public would misinterpret the data and overeact, avoiding certain hospitals and surgeons. There was also concern that the risk adjustment was not accurate, which would cause hospitals to avoid high-risk patients. However, evidence does not show that patients and hospitals reacted as such. Rather, the risk-adjustment appeared accurate and the data, and its publication, had the intended effect of leading to improvements in care. Partly because of the registry, the mortality following CABG in New York declined by 41% during the first four years of the registry's existence. The registry led to the reduction of surgeons who performed the procedure infrequently and a change in the treatment program at one hospital.

Column, Coronary artery bypass, New York. Department of Health

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Improving the quality of care

Article Abstract:

Physicians need to take the lead in identifying and implementing measures to improve the quality of health care. Physicians have been skeptical about quality assurance measures in the past because they could see no benefit for their patients. There has been little evidence in the past that these measures improved patient outcomes. However, this is changing. Practice guidelines based on a review of clinical trials and a consensus among physicians are being published. Hospital-based physicians are finding that clinical algorithms can improve care while cutting costs.

Usage, Practice guidelines (Medicine)

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The relation between volume and outcome in health care

Article Abstract:

The volume of procedures done at a hospital should not be the only determinant of quality. Several studies have shown that hospitals that perform many specific procedures have lower patient mortality rates than those that do few such procedures. However, it appears that hospital volume is a proxy for other measures of quality that cannot easily be measured. One study found that the reason high-volume hospitals had lower mortality rates among heart attack patients was primarily because they were more likely to use aspirin and beta blockers.

Editorial, Hospitals

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