Influence of cardiac-surgery performance reports on referral practices and access to care - A survey of cardiovascular specialists
Influence of cardiac-surgery performance reports on referral practices and access to care - A survey of cardiovascular specialists
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DOI：
10.1056/nejm199607253350406
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发表时间：
1996-07-25
影响因子：
158.5
通讯作者：
Epstein, AM
中科院分区：
文献类型：
--
作者：
Schneider, EC;Epstein, AM
背景医生的比较性能的报告变得越来越普遍。然而，鲜为人知的是，这些报告的可信度与目标受众或其对提供医疗服务的影响。方法自1992年以来，宾夕法尼亚州已经出版了消费者指南冠状动脉旁路移植手术，列出了每年的风险调整后的死亡率为所有医院和外科医生提供这种手术在该州。在1995年，我们调查了随机选择的50%的宾夕法尼亚州心脏病专家和心脏外科医生的样本，以了解他们是否知道该指南，如果是这样，以确定其有用性，局限性和对供应商的影响他们的看法。只有10%的受访者表示，死亡率在评估心胸外科医生的表现时“非常重要”。不到10%的人报告说，他们与超过10%的冠状动脉旁路移植术（CABG）候选人讨论了指南。87%的心脏病专家报告说，指南对他们的转诊建议影响很小或没有影响。对于这两组人来说，指南最重要的局限性是缺乏死亡率以外的质量指标（78%），风险调整不足（79%）以及医院和外科医生提供的数据不可靠（53%）。59%的心脏病专家报告说，越来越难找到外科医生愿意进行CABG手术的重症患者谁需要它，和63%的心脏外科医生报告说，他们不太愿意对这样的patients.Conclusions消费者指南冠状动脉旁路移植术心血管专家之间的可信度有限。它对转诊建议的影响很小，可能会对重症患者的护理造成障碍。如果公开发布的业绩报告旨在指导选择提供者，而不妨碍获得医疗服务，那么加强医生参与的协作过程可能会提高报告的可信度和有用性。(C)1996年，马萨诸塞州医学会。
Background Reports on the comparative performance of physicians are becoming increasingly common. Little is known, however, about the credibility of these reports with target audiences or their influence on the delivery of medical services.Methods Since 1992, Pennsylvania has published the Consumer Guide to Coronary Artery Bypass Graft Surgery, which lists annual risk-adjusted mortality rates for all hospitals and surgeons providing such surgery in the state. In 1995, we surveyed a randomly selected sample of 50 percent of Pennsylvania cardiologists and cardiac surgeons to find out whether they were aware of the guide and, if so, to determine their views on its usefulness, limitations, and influence on providers.Results Eighty-two percent of the cardiologists and all the cardiac surgeons were aware of the guide, Only 10 percent of these respondents reported that its mortality rates were ''very important'' in assessing the performance of a cardiothoracic surgeon. Less than 10 percent reported discussing the guide with more than 10 percent of their patients who were candidates for a coronary-artery bypass graft (CABG). Eighty-seven percent of the cardiologists reported that the guide had a minimal influence or none on their referral recommendations. For both groups, the most important limitations of the guide were the absence of indicators of quality other than mortality (cited by 78 percent), inadequate risk adjustment (79 percent), and the unreliability of data provided by hospitals and surgeons (53 percent). Fifty-nine percent of the cardiologists reported increased difficulty in finding surgeons willing to perform CABG surgery in severely ill patients who required it, and 63 percent of the cardiac surgeons reported that they were less willing to operate on such patients.Conclusions The Consumer Guide to Coronary Artery Bypass Graft Surgery has limited credibility among cardiovascular specialists. It has little influence on referral recommendations and may introduce a barrier to care for severely ill patients. If publicly released performance reports are intended to guide the choice of providers without impeding access to medical care, strengthening the collaborative process involving physicians may enhance the credibility and usefulness of the reports. (C) 1996, Massachusetts Medical Society.