5. Public Reporting as a Quality Improvement Strategy

Author
Year
Pettijohn
1999 157
Schneid
er
1996 138
1. Study
Purpose
and/or a
priori
Hypothesis
To investigate
the impact of
outcomes data
reporting on
the practice of
interventional
cardiology
To find out
whether
cardiologists
and cardiac
surgeons were
aware of the
Pennsylvania
Consumer
Guide to
Coronary
Artery Bypass
Graft Surgery
report, and if
so, to
determine
their views on
its usefulness,
limitations and
influence on
providers
2.
Geographic
Location
3. Study
Design/
Type
USA Descriptive
Survey
Pennsylvania Descriptive
Survey
4. Sample/
Population:
Who or what
is studied? 5. Outcomes
Interventional
Cardiologist
in the USA
(n=1444;
28%
response
rate)
Opinions and
attitudes of
Cardiac
Surgeons
and
Cardiologists
in
Pennsylvania
.
Randomly
selected
sample of 50
percent of
Pennsylvania
cardiologists
and cardiac
surgeons.
Total
response
rate out of
697
physicians
was 65%.
64%
response
overall
response
rate among
cardiologists
and 74%
Self-reported
effects of
outcomes data
reporting on
their approach
to high-risk
patients who
required
interventional
procedures
All self reported:
Awareness of
the guide
Opinion of
usefulness:
importance of
risk-adjusted
mortality;
importance of
clinical
outcomes other
than mortality;
Importance of
Consumer
Guide Ratings;
Influence of
consumer guide
rating on referral
recommendatio
ns; Discussed
Consumer
Guide with
percentage of
patients.
Opinion of
limitations:
multiple
K-17
6. Name of
Report or
Subject
Matter 7. Results 8. Summary
NR 85% of the cardiologists followed
their own outcomes data. Of the
respondents, 12% said that
outcomes reporting would have
no effect on their willingness to
perform procedures on high-risk
patients. 88% of the respondents
said that if outcomes were
reported, they would be
somewhat or much less likely to
perform interventions on high-risk
PA
Consumer
Guide to
Coronary
Artery
Bypass
Graft
Surgery
patients.
Aware of Cardiac Guide:
Cardiologists: 82%
Surgeons: 100%
Views on Importance of
Outcomes and the Consumer
Guide in Assessing the Quality of
a Cardiac Surgeon’s
Performance: [#,(%) for
Cardiologists; #,(%)for Cardiac
Surgeons]
Importance of risk-adjusted
mortality***:
Minimally or not important: 11(5);
8(14)
Moderately Important: 32(12);
15(26)
Very or extremely important:
227(84); 35(60)
Importance of clinical outcomes
other than mortality**:
Minimally or not important: 3(1);
3(5)
Moderately important: 31(12);
12(21)
Very or extremely important:
236(87); 423(74)
Authors’ results
support the
hypothesis that
outcomes
reporting would
limit the access
of high-risk
patients to
interventional
cardiology
procedures in
the USA
All cardiac
surgeons were
aware of the
report and most
of the
cardiologists
were. Overall,
both groups
thought there
were some
limitations to
the report, but
the biggest
potential impact
seemed to be in
access to care
for highest risk
patients; 63%
of surgeons
said that they
were less
willing or much
less willing to
operate. None
were more
willing. Of the
cardiologists, a
majority (59%)
said it was at
least somewhat
9. Funder of
Research
NR
Henry J.
Kaiser Family
Foundation,
National
Research
Service
Award from
the
Department
of Health and
Human
Services