When deciding on which car or college — or, increasingly, health care provider — to choose, many of us compare reviews and ratings in such sources as Consumer Reports and U.S. News & World Report. More than two decades ago, the New York State Department of Health, itself, began to report information on cardiac surgery because the Commissioner of Health noticed wide variations in mortality rate and complications reported by different hospitals in the state.
History of Cardiac Surgery Reporting in New York
Results, adjusted for patient risk, were first released to the New York Times in 1990 with the hospitals numbered, but not named. However, the following day, the hospitals were named and, after a lawsuit based on the Freedom of Information Act, mortality figures for individual surgeons were made public within a few years. Risk adjustment methodology aimed to correct for how severely ill the patients were in any one doctor’s practice or in any single hospital, to allow for valid comparisons.
There was intense interest in those early days, with newspapers publishing performance “league tables” on the front page. Similar public reporting systems followed in other states. With time, the novelty wore off, and now, when the results are published, they appear buried deep in the middle of local tabloids.
Benefits, and Shortcomings, of the Reporting System
What has the benefit of the New York reporting system been, and what should members of the public make of the information? In states like New York and others that began reporting on cardiac surgery, but also in states where public reporting of collected information was not a feature, the risk of dying from coronary bypass surgery fell significantly. For hospitals and surgeons, comparative data can be useful to guide efforts aimed at continuous improvement of quality care.
The system is not without its problems. Unfortunately, published results in New York appear almost three years after the information is gathered. Complex statistical models are used to analyze the data, but most people, including physicians, are not qualified to interpret the nuances.
In reality, the mortality rates of almost all hospitals and surgeons in every reporting cycle are statistically NOT different. So, for example, if one hospital has a mortality rate of 2.2% and another has 2.4%, there is no evidence of a difference between the two, even if by reflex we think the lower mortality is better. Movement up and down the league table from year to year is quite random and suggests that most differences are the product of chance.
Discussion with Surgeon the Best Way to Estimate Risks and Benefits of Surgery
Coronary bypass surgery has been performed for 50 years, and exceptional results are now being achieved, even as the average patient is older, sicker and more complex. At Beth Israel Medical Center, every coronary bypass is performed by two experienced surgeons, with a dedicated team to support them, and post-operative care is supervised personally by the cardiac surgeons — not delegated to other practitioners. No care is provided by residents (doctors in training). For patients, a full discussion with their surgeons and heart team will allow proper estimation of the risks and benefits of surgery.