StATS: Report cards (February 16, 2005)

The Minnesota Department of Health recently published a report over a 15 month period that documenting 99 events occurring in Minnesota hospitals that should never occur. This included things like wrong-site surgery, pressure ulcers, and misuse of medical devices. Among these events, 20 resulted in a patient death.

This is an example of the increasing demand that hospitals and other health care organizations produce "report cards" that tell the public how well or poorly they are doing. We need to be cautious about reporting this type of information because if it is presented poorly, it may unfairly taint the reputation of individuals or organizations. In particular, if a group of doctors takes on the most difficult cases because of their unique skill, their rates of adverse outcomes will be higher, unless some risk adjustment is made.

There's an entire book on risk adjustment,

and a lot more research needs to be done on this topic. A recently published article in BMJ about report cards for cardiothoracic surgeons has the following quote:

A BMA spokesperson agreed that patients should have high quality information. However, the BMA would oppose the use of crude mortality data. "Evidence from other countries shows that some surgeons are deterred from taking on very complex and therefore high risk procedures because published simplistic leagues tables count against them," the spokesperson said. "We are keen to work with the government and patients to develop meaningful and accurate data that will enhance patient choice."

Further reading (new reference added March 23, 2005):

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