Several states began publishing coronary artery bypass graft (CABG) report cards in the 1990s in an effort to improve the quality of CABG care in those states. Report cards are a state-level initiative, typically administered by a state's Department of Health.
These report cards report risk-adjusted death rates for surgeons and hospitals that perform CABG surgery. They are designed to improve quality by enabling patients to select high-quality providers and giving providers benchmarks and incentives to improve the quality of care they provide. Recent evidence suggests that after CABG report cards were released, surgeons began to avoid patients they perceived as being high-risk.
"In our study we found that health care report cards, as they are currently implemented, may have the opposite effect of how they were intended to work," said Rachel M. Werner, M.D., the study's first author and an assistant professor of medicine at the University of Pennsylvania School of Medicine in Philadelphia and staff physician at the Philadelphia Veterans Affairs Medical Center. "One implication of our study is that report cards work in ways that are more complicated than we assumed, and some physicians may respond to them inappropriately."
The researchers reviewed physician-specific report card data in New York. New Jersey and Pennsylvania also publish physician-specific CABG report cards. All three states also issue hospital-specific report cards. California has hospital-specific report cards only.
Among the states studied (New York plus 12 controls) only New York released CABG report cards during the study period from 1988-95. Control states were defined by data from the Healthcare Cost an
Contact: Carole Bullock
American Heart Association