Medical Report Cards Have Little Impact on Patients' Choice of Hospitals, Surgeons
For immediate release: May 26, 1998
Chicago, IL--Most patients are not aware of public performance reports of hospitals and surgeons, and of those with the data, only about 20 percent said it influenced their decisions, according to an article in the May 27th issue of The Journal of the American Medical Association (JAMA).
Eric C. Schneider, M.D., and Arnold M. Epstein, M.D. of the Harvard School of Public Health and Brigham and Women's Hospital in Boston, examined the awareness and use of a Pennsylvania statewide consumer guide by 474 patients who had undergone coronary artery bypass graft (CABG) surgery at one of the four hospitals listed in the Consumer Guide as having average mortality rates between 1 percent and 5 percent.
The Consumer Guide is a performance report of risk-adjusted mortality rates of every Pennsylvania hospital, surgeon and surgical group providing CABG surgery. The Consumer Guide is distributed to hospitals, surgeons, public libraries, business groups, legislators and the media. It is free to any individual who requests it.
The researchers found that only 12 percent of patients surveyed reported awareness of a report on cardiac surgery mortality before undergoing the surgery. Fewer than 1 percent knew the correct rating of their surgeon or hospital and reported that it had a moderate or major impact on their selection of provider.
The survey assessed patients' perception and decision making prior to cardiac surgery. The survey questioned patients' awareness of an available publication (The Consumer Guide); use of the guide and information; interest in performance reports; and limitations to using such reports.
Fifty-eight percent of all patients surveyed reported that they probably or definitely would change surgeons if they learned that their surgeon has a higher than expected mortality rate in the previous year. Limited time for decision-making and a limited awareness of alternative hospitals within a reasonable distance of home were identified as important barriers to using performance reports.
The study uncovered conflicting information as many patients expressed an interest in seeing a copy when it was described to them, yet few used such guides. After the content of the Consumer Guide was described to all patients, 56 percent reported being somewhat or very interested in seeing a copy if they required another operation.
Commenting on the results of a different study, the researchers noted that "the public values anecdotal reports from relatives and friends more than objective reports from other sources such as the government and the news media."
They added: "Efforts to aid patient decision making with performance reports are unlikely to succeed without a tailored and intensive program for dissemination and patient education. ... Further efforts to develop quality information for general public use should explore the use of Internet-based and other media for communicating quality information."
Cardiac surgery is a dramatic event, frequently elective, with a significant operative mortality rate. Previous studies have shown that mortality rate variations are related to the quality of care. (JAMA. 1998;279:1638-1642)
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