Cardiac Report Cards

When hospital- and surgeon-specific coronary artery bypass graft surgery death rates were first publicly released in 1991 in New York State, many clinicians reacted with anger and outright hostility.1 Over time, as more jurisdictions adopted the concept of public reporting of outcomes in the form of report cards, the view has shifted to gradual recognition and acceptance that cardiac report cards, however imperfect, are here to stay.Articles pp 2960 and 2969 Professional associations such as the American College of Cardiology and American Heart Association have recognized the importance of measuring the processes and outcomes of cardiovascular care as a critical step in improving the quality of care delivered to patients.2 The field of cardiovascular medicine has been at the forefront of the “accountability” movement in health care for a number of reasons. Cardiovascular disease affects large sectors of the population, because conditions such as acute myocardial infarction and procedures such as bypass surgery are quite common, and tracking of hard objective outcomes such as death are readily available. Furthermore, much clinical research has focused on cardiovascular disease and generated a large base of scientific evidence on which care can be assessed and improved. Most recently, policy makers have embraced the concept of “pay for performance,” which is based on the premise that economic rewards may stimulate better quality of care delivery.3The debate about report cards has progressed from fundamental disagreements about their purpose and usefulness to discussions that focus on their content and the statistical methodology to be utilized. Poor performance on a public report card can have a potentially devastating impact on an individual’s career or on a hospital’s reputation. As such, the stakes for cardiovascular practitioners such as cardiac surgeons, cardiologists, and their hospitals are particularly high. At this time, however, many clinicians …