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Publishing report cards about a surgeon's quality influences consumer selection of surgeons

Publicly disseminated report cards that evaluate the quality of cardiac surgeons have an impact on surgeon selection, according to a recent study of report card experience in New York State. The researchers examined the impact of the New York State Cardiac Surgery Reports on selection of cardiac surgeons. The reports included the number of coronary artery bypass graft (CABG) cases, risk-adjusted mortality rate (RAMR), and designation of outlier status (much higher or lower RAMR than others) for each hospital and for each cardiac surgeon. The reports were put on the World Wide Web and sent to New York cardiologists to aid their referral recommendations.

The study included all Medicare fee-for-service enrollees aged 65 and older in New York State who underwent CABG procedures during 1991 and 1992. Medicare FFS enrollees are not limited in their selection of physicians and surgeons. The study was supported in part by the Agency for Healthcare Research and Quality (HS09803) and led by Dana B. Mukamel, Ph.D., of the University of California, Irvine. Dr. Mukamel and colleagues compared selection of surgeons in 1991 (pre-report publication) and 1992 (post-report publication). A higher RAMR (that is, lower quality) lowered a surgeon's odds of being selected by about 7 to 8 percent.

Explicit information in the report cards appeared to replace implicit factors consumers usually interpret as signals of quality—such as higher price and more years of experience—which carried less weight after report publication. However, referring physician loyalty did not change after report card publication, suggesting that physicians may need to observe consistent RAMR scores over several years to change referral patterns.

Patients residing in more affluent and more educated neighborhoods (who are more capable of accessing and using the report information) were more likely to be treated by low RAMR (high quality) surgeons in the post-report period. Finally, selection of surgeons for black patients was as sensitive to the published information as it was for white patients.

See "Quality report cards, selection of cardiac surgeons, and racial disparities: A study of the publication of the New York State cardiac surgery reports," by Dr. Mukamel, David L. Weimer, Ph.D. Jack Zwanziger, Ph.D., and others in the Winter 2004 Inquiry 41, pp. 435-446.

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