title: Understanding The Strengths And Weaknesses Of Public Reporting Of Surgeon-Specific Outcome Data.
abstract: Public reporting of outcome data is increasingly being used at the institutional and clinician levels and has become mandatory in some parts of the United States and the United Kingdom. The intended benefits are to drive quality improvement, demonstrate transparency, facilitate patient choice, and allow identification of poor performance. Public reporting of surgeon-specific mortality data, however, may have unintended consequences that include causing surgeons to become risk-averse, discouraging innovation, having an impact on training, and prompting "gaming" in health care. Given the small number of some surgical operations performed by individual surgeons, such data are unlikely to identify outliers or poor performers in a valid way. If metrics are deemed necessary and required to be reported publicly, they should be procedure specific; account for sample size; and focus not solely on mortality but also on other outcomes such as quality of life, patient satisfaction, and experience.
authors.affiliation: Elaine M. Burns (eburns@imperial.ac.uk) is an honorary clinical lecturer in the Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, in the United Kingdom.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Burns
authors.affiliation: Chris Pettengell is a clinical research fellow in the Department of Surgery and Cancer, Faculty of Medicine, Imperial College London.
authors.forename: Chris
authors.initials: C
authors.lastname: Pettengell
authors.affiliation: Thanos Athanasiou is a professor of cardiovascular sciences in the Department of Surgery and Cancer, Faculty of Medicine, Imperial College London.
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.affiliation: Ara Darzi is executive chair of the World Innovation Summit for Health (WISH), Qatar Foundation, and director of the Institute of Global Health Innovation, Imperial College London.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D032882:Comprehension; D019317:Evidence-Based Medicine; D005260:Female; D013502:General Surgery; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D066308:Public Service Announcements as Topic; D011785:Quality Assurance, Health Care / Q000592:standards*; D012107:Research Design; D066231:Surgeons / Q000592:standards* / Q000639:trends; D006113:United Kingdom; D014481:United States
keywords: Evidence-Based Medicine; Quality Of Care