Use of public performance reports - A survey of patients undergoing cardiac surgery
Use of public performance reports - A survey of patients undergoing cardiac surgery
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DOI：
10.1001/jama.279.20.1638
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发表时间：
1998-05-27
影响因子：
120.7
通讯作者：
Epstein, AM
中科院分区：
文献类型：
--
作者：
Schneider, EC;Epstein, AM
背景--公开发布的业绩报告(“成绩单”)有望在质量的基础上促进竞争。支持者经常将告知患者选择医生和医院的必要性作为这一战略的核心要素。目标-检查全州消费者指南的意识和使用情况，该指南提供提供心脏手术医院的风险调整后的住院死亡率评级。设计-1996年进行的电话调查。设置。-宾夕法尼亚州，自1992年以来，《宾夕法尼亚州冠状动脉搭桥手术消费者指南》提供了该州所有心脏外科医生和医院的风险调整死亡率评级。参与者。-在消费者指南中列出的平均死亡率在1%至5%之间的4家医院中的1家，在前一年接受过冠状动脉搭桥手术的673名符合条件的患者中，共有474人(70%)成功接触到。主要结果衡量标准。-患者对消费者指南的认识、他们对其评级的了解、他们对该报告的兴趣程度以及使用该指南的障碍。结果-93名患者(20%)知道消费者指南，但只有56人(12%)在手术前知道。在这56名患者中，18人报告知道医院评级，7人报告知道外科医生评级，11人表示医院和/或外科医生评级对他们的决策有中等或重大影响，但只有4人能够正确指定其中之一或两者都正确。当向所有患者描述《消费者指南》时，264名(56%)的患者对看到该指南的副本感兴趣，273名(58%)的患者表示，如果他们得知自己的外科医生在前一年的死亡率高于预期，他们可能或肯定会更换外科医生。较短的决策时间窗口和对离家合理距离内的替代医院的有限认识被认为是使用的重要障碍。结论：只有12%的受访患者报告在接受心脏手术前知道一份关于心脏手术死亡率的重要报告。只有不到1%的人知道他们的外科医生或医院的正确评级，并报告说这对他们选择提供者产生了中等或重大的影响。如果没有一个量身定做的密集的传播和患者教育计划，用绩效报告帮助患者决策的努力不太可能成功。
Context.-Publicly released performance reports ("report cards") are expected to foster competition on the basis of quality. Proponents frequently cite the need to inform patient choice of physicians and hospitals as a central element of this strategy.Objective.-To examine the awareness and use of a statewide consumer guide that provides risk-adjusted, in-hospital mortality ratings of hospitals that provide cardiac surgery.Design.-Telephone survey conducted in 1996.Setting.-Pennsylvania, where since 1992, the Pennsylvania Consumer Guide to Coronary Artery Bypass Graft [CABG] Surgery has provided risk-adjusted mortality ratings of all cardiac surgeons and hospitals in the state.Participants.-A total of 474 (70%) of 673 eligible patients who had undergone CABG surgery during the previous year at 1 of 4 hospitals listed in the Consumer Guide as having average mortality rates between 1% and 5% were successfully contacted.Main Outcome Measures.-Patients' awareness of the Consumer Guide, their knowledge of its ratings, their degree of interest in the report, and barriers to its use.Results.-Ninety-three patients (20%) were aware of the Consumer Guide, but only 56 (12%) knew about it before surgery. Among these 56 patients, 18 reported knowing the hospital rating and 7 reported knowing the surgeon rating, 11 said hospital and/or surgeon ratings had a moderate or major impact on their decision making, but only 4 were able to specify either or both correctly. When the Consumer Guide was described to all patients, 264 (56%) were "very" or "somewhat" interested in seeing a copy, and 273 (58%) reported that they probably or definitely would change surgeons if they learned that their surgeon had a higher than expected mortality rate in the previous year. A short time window for decision making and a limited awareness of alternative hospitals within a reasonable distance of home were identified as important barriers to use.Conclusions.-Only 12% of patients surveyed reported awareness of a prominent report on cardiac surgery mortality before undergoing cardiac surgery. Fewer than 1% knew the correct rating of their surgeon or hospital and reported that it had a moderate or major impact on their selection of provider. Efforts to aid patient decision making with performance reports are unlikely to succeed without a tailored and intensive program for dissemination and patient education.