Conducted by Narins with Frederick Ling, M.D., Wojciech Zareba, M.D., Ph.D., and Ann Dozier, R.N., Ph.D., the survey received an extraordinary 65 percent response rate. Investigators speculate that doctors responded in such large numbers because they want the public to know that a physician's mortality rate, the only statistic measured on the state's report card, is by itself an inaccurate indicator of the physician's skill level or quality of care.

Of the 120 physicians who responded to the survey, the vast majority agreed or strongly agreed that the publication of mortality statistics has, in certain instances, influenced their decision regarding whether to perform angioplasty on individual patients. Physicians expressed an increased reluctance to intervene upon critically ill patients with high-expected mortality rates, even though these patients may have the most to gain from angioplasty.

Among the respondents, 83 percent agreed or strongly agreed that patients who might benefit from angioplasty may not receive the procedure as a result of public reporting of physician-specific mortality rates. The scoring system attempts to not penalize physicians as much when a more severely ill patient dies following a procedure; yet 85 percent of those surveyed believed that the risk adjustment model used in New York is not sufficient to avoid punishing physicians who perform higher-risk interventions.

The state reporting system may, as intended, lead some interventional cardiologists with low volumes or poor outcomes to improve their performance or stop performing the procedure. However, researchers say the unintended effects of the scorecard system on patient care decisions, as described in the paper, may adversely affect outcomes for patients who might benefit from angioplasty but are denied the procedure.

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Contact: Karin Gaffney
karin_gaffney@urmc.rochester.edu
585-275-1311
University of Rochester Medical Center
10-Jan-2005