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Health report-card fears make doctors forgo potential life-saving heart treatment

instance, a case of a very ill patient who presents to the emergency room with a large heart attack that is complicated by shock. Attempting to unplug the patient's blocked artery with an angioplasty procedure has been shown to save heart muscle and reduce the patient's chance of dying, but even if the cardiologist decides to perform angioplasty, some patients will not survive," Narins says. "So the cardiologist must decide whether to perform a procedure that is possibly life-saving for the patient at the risk of making their own statistics will look worse."

If the patient receives necessary angioplasty, but ultimately dies from their illness, that death still shows up on the cardiologist's record and counts against them as well as their medical institution when the state Department of Health releases cardiac mortality data. However, if the cardiologist decides not to perform the angioplasty, which may increase the patient's chance of dying, their statistics will not be affected. In this way, the presence of the report card may in some instances influence a doctor not to perform a procedure that may be helpful for the patient.

"There is a fear among health care professionals that as more states adopt mortality data reports, insurers may direct patients to hospitals with better scores, even though better scores probably do not correlate with better patient care," Narins says.

At the University of Rochester Medical Center, protocol dictates that all patients, regardless of their expected outcome, be treated in the cardiac catheterization lab if there is a chance they may benefit from angioplasty.

"Our numbers, although at times above the state average, reflect the deaths of patients who came to us critically ill," says Ling, director of the cardiac catheterization lab. "We're aware of the potential outcome, but it is our duty as physicians to treat patients to the best of our ability."


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


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