 |
 |
|
|
|  PubMed
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 January 1994 | Volume 120 Issue 1 | Pages 65-70
Public release of operator-specific data for cardiovascular procedures has set a new precedent, introducing the "scorecard" era. Justification exists for public disclosure, but the mechanics of appropriate data release are complex from a clinical, statistical, and logistic standpoint. Scorecard medicine may appropriately promote regionalization of medical centers and consolidation of services, but unless the process is directed effectively, it may impair the development of new treatments because of a more restrictive clinical practice environment.
We propose revamping our current system to facilitate rapid and accurate access to outcome data in the local practice environment so that improvement in practice occurs on a voluntary basis rather than in response to punitive restrictions.A rational plan needs to be developed for dealing with high-risk patients, perhaps through compensation in regression models used to calculate expected outcomes, and for the start-up of novice physicians. Special provisions are needed to promote clinical research. Before procedures are done, it would be ideal to provide a full disclosure informed consent, whereby the physician reports operator-specific data and the patient's decision-making process is facilitated. Overall, appropriate implementation of scorecards could ultimately lead to a substantial improvement in the quality of U.S. cardiovascular medicine.
Author and Article Information
From the Cleveland Clinic Foundation, Cleveland, Ohio; Duke University School of Medicine, Durham, North Carolina.
MEDICINE AND PUBLIC ISSUES
Scorecard Cardiovascular Medicine: Its Impact and Future Directions
Requests for Reprints: Eric J. Topol, MD, Department of Cardiology, Cleveland Clinic Foundation, Desk F25, 9500 Euclid Avenue, Cleveland, OH 44195.
Acknowledgments: The authors thank Daniel Mark, MD, MPH; David Pryor, MD; and Edward Hannon, PhD, for their careful review and critique of the manuscript.
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  R. M. Califf and E. D. Peterson Public reporting of quality measures what are we trying to accomplish? J. Am. Coll. Cardiol., March 10, 2009; 53(10): 831 - 833. [Full Text] [PDF]
|
|
|
|
 |
|
 L. S. Halpin, S. D. Barnett, L. L. Henry, E. Choi, and N. Ad Public Health Reporting: The United States Perspective Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2008; 12(3): 191 - 202. [Abstract] [PDF]
|
|
|
|
 |
|
 C. A. Beck, H. Richard, J. V. Tu, and L. Pilote Administrative Data Feedback for Effective Cardiac Treatment: AFFECT, A Cluster Randomized Trial JAMA, July 20, 2005; 294(3): 309 - 317. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. R. Narins, A. M. Dozier, F. S. Ling, and W. Zareba The Influence of Public Reporting of Outcome Data on Medical Decision Making by Physicians Arch Intern Med, January 10, 2005; 165(1): 83 - 87. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Lauer Clinical Epidemiology, Clinical Care, and the Public's Health Mayo Clin. Proc., August 1, 2004; 79(8): 975 - 976. [PDF]
|
|
|
|
 |
|
 D. M. Shahian, S.-L. Normand, D. F. Torchiana, S. M. Lewis, J. O. Pastore, R. E. Kuntz, and P. I. Dreyer Cardiac surgery report cards: comprehensive review and statistical critique Ann. Thorac. Surg., December 1, 2001; 72(6): 2155 - 2168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. D. Peterson, E. R. DeLong, L. H. Muhlbaier, A. B. Rosen, H. E. Buell, C. I. Kiefe, and T. F. Kresowik Challenges in comparing risk-adjusted bypass surgery mortality results: Results from the Cooperative Cardiovascular Project J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2174 - 2184. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. R. Holmes Jr, P. B. Berger, K. N. Garratt, V. Mathew, M. R. Bell, G. W. Barsness, S. T. Higano, D. E. Grill, L. N. Hammes, and C. S. Rihal Application of the New York State PTCA Mortality Model in Patients Undergoing Stent Implantation Circulation, August 1, 2000; 102(5): 517 - 522. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. N. Marshall, P. G. Shekelle, S. Leatherman, and R. H. Brook The Public Release of Performance Data: What Do We Expect to Gain? A Review of the Evidence JAMA, April 12, 2000; 283(14): 1866 - 1874. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. N Marshall, P. G Shekelle, S. Leatherman, and R. H Brook Public disclosure of performance data: learning from the US experience Qual. Saf. Health Care, March 1, 2000; 9(1): 53 - 57. [Full Text]
|
|
|
|
|
|
A. Kastrati, F.-J. Neumann, and A. Schomig Operator volume and outcome of patients undergoing coronary stent placement J. Am. Coll. Cardiol., October 1, 1998; 32(4): 970 - 976. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. D. Peterson, E. R. DeLong, J. G. Jollis, L. H. Muhlbaier, and D. B. Mark The effects of New York's bypass surgery provider profiling on access to care and patient outcomes in the elderly J. Am. Coll. Cardiol., October 1, 1998; 32(4): 993 - 999. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Epstein Rolling Down the Runway: The Challenges Ahead for Quality Report Cards JAMA, June 3, 1998; 279(21): 1691 - 1696. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. G. Jollis and P. S. Romano Pennsylvania's Focus on Heart Attack -- Grading the Scorecard N. Engl. J. Med., April 2, 1998; 338(14): 983 - 987. [Full Text]
|
|
|
|
 |
|
 L. Southgate and D. Dauphinee Continuing medical education: Maintaining standards in British and Canadian medicine: the developing role of the regulatory body BMJ, February 28, 1998; 316(7132): 697 - 700. [Full Text]
|
|
|
|
|
|
E. C. Schneider and A. M. Epstein Influence of Cardiac-Surgery Performance Reports on Referral Practices and Access to Care -- A Survey of Cardiovascular Specialists N. Engl. J. Med., July 25, 1996; 335(4): 251 - 256. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. T. O'Connor, S. K. Plume, E. M. Olmstead, J. R. Morton, C. T. Maloney, W. C. Nugent, F. Hernandez Jr, R. Clough, B. J. Leavitt, L. H. Coffin, et al. A Regional Intervention to Improve the Hospital Mortality Associated With Coronary Artery Bypass Graft Surgery JAMA, March 20, 1996; 275(11): 841 - 846. [Abstract] [PDF]
|
|
|
|
|
|
R. M. Califf, J. G. Jollis, and E. D. Peterson Operator-Specific Outcomes : A Call to Professional Responsibility Circulation, February 1, 1996; 93(3): 403 - 406. [Full Text]
|
|
|
|
|
|
N. A. Omoigui, D. P. Miller, K. J. Brown, K. Annan, D. Cosgrove III, B. Lytle, F. Loop, and E. J. Topol Outmigration For Coronary Bypass Surgery in an Era of Public Dissemination of Clinical Outcomes Circulation, January 1, 1996; 93(1): 27 - 33. [Abstract] [Full Text]
|
|
|
|
|
|
T. J. Ryan The Critical Question of Procedure Volume Minimums for Coronary Angioplasty JAMA, October 11, 1995; 274(14): 1169 - 1170. [Abstract] [PDF]
|
|
|
|
|
|
W. D. Dauphinee Assessing Clinical Performance: Where Do We Stand and What Might We Expect? JAMA, September 6, 1995; 274(9): 741 - 743. [Abstract] [PDF]
|
|
|
|
|
|
J. Green and N. Wintfeld Report Cards on Cardiac Surgeons -- Assessing New York State's Approach N. Engl. J. Med., May 4, 1995; 332(18): 1229 - 1233. [Full Text]
|
|
|
|
 |
|
 R. K. Orr, B. S. Maini, F. D. Sottile, E. M. Dumas, and P. O'Mara A Comparison of Four Severity-Adjusted Models to Predict Mortality After Coronary Artery Bypass Graft Surgery Arch Surg, March 1, 1995; 130(3): 301 - 306. [Abstract] [PDF]
|
|
|
|
|
|
T. A. Denton, A. Chaux, and J. M. Matloff A Cardiothoracic Surgery Information System for the Next Century: Implications for Managed Care Ann. Thorac. Surg., February 1, 1995; 59(2): 486 - 493. [Abstract] [Full Text]
|
|
|
|
|
|
J. T. Kelly Evaluating Quality Performance in Alternate Health Care Delivery Systems: A Critical Challenge JAMA, May 25, 1994; 271(20): 1620 - 1621. [Abstract] [PDF]
|
|
|
|
|
|
T. S. Jost Health System Reform: Forward or Backward With Quality Oversight? JAMA, May 18, 1994; 271(19): 1508 - 1511. [Abstract] [PDF]
|
|
