There has been a shift towards making quality data publicly available for patients to examine when choosing physicians. A commentary by Burns et al. (2016) finds that there is mixed evidence regarding whether making surgery-related mortality data publicly available improves patient outcomes (see table below).
|Article||Time Period||Country||Participants||Key Findings|
|Hannan 1994||1989-1992||US||NY State cardiac surgeons performing CABG||Reduction in risk-adjusted mortality across all groups, with the groups that showed the highest initial mortality manifesting the most improvement|
|Bridgewater 2007||1997-2005||UK||All patients undergoing CABG in northwest England||Significant decline in observed to expected mortality ratio,
from 2.4 to 1.8, after UK mortality data published
|Khan 2007||2000-2004||UK||All patients undergoing CABG or aortic valuve or mitral valve surguries in a single hospital in England||No change in overall mortality rate following publication of mortality rate data|
|Li 2010||2003-2006||US||All CABG patients from California’s Outcomes Reporting Program||Decline in observed mortality (2.22% from 2.90%)|
However, the authors also note that even if reporting quality outcomes may improve quality in aggregate, identifying very high and very low quality surgeons from publicly reported data is very difficult. First, most surgeons perform a small number of each type of surgical procedures. Second, risk adjustment is typically insufficient and could penalize surgeons from taking more complex cases. Third, other outcomes–such as quality of life and patient satisfaction, typically are not included in the measure, but surgeons may have more control over the surgical experience than mortality if risk adjustment is imperfect.
I am completely in favor of making more data publicly available. The quality of the data-whether or not it is publicly released–must always be carefully scrutinized when attempting to answer any research question.
- Elaine M. Burns*, Chris Pettengell, Thanos Athanasiou and Ara Darzi. Understanding The Strengths And Weaknesses Of Public Reporting Of Surgeon-Specific Outcome Data.
- Health Aff
- March 2016 vol. 35 no. 3 415-421. 10.1377/hlthaff.2015.0788