Implementation of a cardiac surgery report card: lessons from the Massachusetts experience.
Demand is increasing for public accountability in health care. In 2000, the Massachusetts legislature mandated a state report card for cardiac surgery and percutaneous coronary interventions. During the planning and implementation of this report card, a number of observations were made that may prove useful to other states faced with similar mandates. These include the necessity for constructive, nonadversarial collaboration between regulators, clinicians, and statisticians; the advantages of preemptive adoption of The Society of Thoracic Surgeons [STS] National Cardiac Database, preferably before a report card is mandated; the support and resources available to cardiac surgeons through the STS, the National Cardiac Database Committee, and the Duke Clinical Research Institute; the value of a state STS organization; and the importance of media education to facilitate fair and dispassionate press coverage. Some important features of report cards may vary from state to state depending on the legislative mandate, local preferences, and statistical expertise. These include the choice of a statistical model and analytical technique, national versus regional reference population, and whether individual surgeon profiling is required.
Shahian
David M
DM
Department of Surgery, Caritas St. Elizabeth's Medical Center, Boston, MA 02135, USA. david_shahian@cchcs.org
Torchiana
David F
DF
Normand
Sharon-Lise T
SL
D003625:Data Collection / Q000331:legislation & jurisprudence / Q000379:methods; D016208:Databases, Factual; D006801:Humans; D037141:Mandatory Programs / Q000458:organization & administration; D008404:Massachusetts; D016730:Program Development / Q000379:methods*; D011641:Public Relations; D011785:Quality Assurance, Health Care / Q000379:methods / Q000458:organization & administration*; D013219:State Government; D013223:Statistics as Topic / Q000458:organization & administration; D013903:Thoracic Surgery / Q000458:organization & administration* / Q000706:statistics & numerical data