title: Public reporting of cardiac surgery performance: Part 1--history, rationale, consequences.
abstract: Cardiac surgical report cards have historically been mandatory. This paradigm changed when The Society of Thoracic Surgeons recently implemented a voluntary public reporting program based on benchmark analyses from its National Cardiac Database. The primary rationale is to provide transparency and accountability, thus affirming the fundamental ethical right of patient autonomy. Previous studies suggest that public reporting facilitates quality improvement, although other approaches such as confidential feedback of results and regional quality improvement initiatives are also effective. Public reporting has not substantially impacted patient referral patterns or market share. However, this may change with implementation of healthcare reform and with refinement of public reporting formats to enhance consumer interpretability. Finally, the potential unintended adverse consequences of public reporting must be monitored, particularly to assure that hospitals and surgeons remain willing to care for high-risk patients.
authors.affiliation: Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. dshahian@partners.org
authors.forename: David M
authors.initials: DM
authors.lastname: Shahian
authors.forename: Fred H
authors.initials: FH
authors.lastname: Edwards
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.forename: Richard L
authors.initials: RL
authors.lastname: Prager
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Shewan
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
mesh_terms: D019985:Benchmarking / Q000941:ethics* / Q000639:trends*; D006348:Cardiac Surgical Procedures / Q000941:ethics* / Q000639:trends*; D003258:Consumer Behavior; D004992:Ethics, Medical; D005246:Feedback; D005544:Forecasting; D018166:Health Care Reform / Q000941:ethics / Q000639:trends; D006305:Health Status Indicators; D006801:Humans; D016749:National Practitioner Data Bank / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000941:ethics* / Q000639:trends*; D026684:Personal Autonomy; D058996:Quality Improvement / Q000941:ethics / Q000639:trends; D019984:Quality Indicators, Health Care / Q000941:ethics* / Q000639:trends*; D012941:Social Responsibility; D014481:United States