How do public 'report cards' affect physicians' treatment decisions?

May 10, 2018, Beth Israel Deaconess Medical Center
A new survey finds that two-thirds of interventional cardiologists have avoided potentially lifesaving procedures for high-risk patients when results are publicly reported. Credit: The Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center

Public "report cards" on outcomes for patients who have undergone percutaneous coronary intervention (PCI or coronary angiography) were originally developed to increase transparency and improve care, but studies have shown that these reports may inadvertently discourage physicians from offering this lifesaving treatment to patients at high risk for poor outcomes.

Researchers from the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center (BIDMC) now provide a closer look at physicians' knowledge, attitudes and beliefs about PCI public reporting. In a study published online today in JAMA Cardiology, the researchers describe the results of a comprehensive survey of interventional cardiologists in two states that mandate public reporting. Their overall results show that risk-averse attitudes and practice patterns remain widespread when clinical results are publicly reported.

"Our primary results showed that among the interventional cardiologists who responded, almost two-thirds reported avoiding performing an indicated coronary intervention on at least two occasions due to a concern that an adverse event might negatively affect their publicly reported outcomes," said senior author Robert W. Yeh, MD, MBA, Director of the Smith Center and an interventional cardiologist at BIDMC. "A similar number reported that they had been pressured by colleagues to avoid performing PCIs—even if it was the preferred procedure for the patient's condition—if there was a risk of a bad outcome."

The online survey was sent to 456 interventional cardiologists in Massachusetts and New York (where public reporting is mandated). The survey was developed and distributed by the Smith Center in collaboration with the Society for Cardiovascular Angiography and Interventions and the American College of Cardiology's Interventional Council.

The results showed that:

  • 65 percent of respondents had avoided performing a medically indicated PCI at least twice due to concerns about public reporting;
  • 59 percent reported "sometimes" or "often" being pressured by colleagues to avoid PCI due to concern about a patient's mortality risk;
  • 95 percent believed that other cardiologists in their state sometimes or often avoid PCI due to concerns about public reporting.

"Despite reforms intended to limit reporting of outcomes for the highest-risk patients undergoing PCI, current programs continue to engender risk-averse clinical practice," said the study's first author Daniel Blumenthal, MD, MBA, an investigator in the Smith Center at BIDMC, a at the Massachusetts General Hospital and an Instructor in Medicine at Harvard Medical School. "This is the first time we asked interventional cardiologists in multiple states in-depth questions about how these public reports influence their clinical decisions. Their answers revealed that unintended consequences of public reporting continue to undermine the policy."

"I think that when developing policies intended to improve quality of care and transparency, policy makers have to talk to the physicians to find out how these policies might change their behavior," added Yeh, who is also an Associate Professor of Medicine at Harvard Medical School. "We need more engagement and input from the people who are actually caring for the patients. While I believe there is an important place for public reporting, we always need to take into account the human factor, which may arise in unexpected ways."

Explore further: Excluding high-risk cardiac patients from public reporting linked to improved outcomes

Related Stories

Excluding high-risk cardiac patients from public reporting linked to improved outcomes

July 27, 2016
A number of states - including Massachusetts and New York - mandate public reporting of mortality outcomes following certain cardiac procedures. While such reporting was originally intended to increase transparency and improve ...

Study finds hospital quality report cards and readmission penalties may not tell whole story

March 26, 2018
Over the past several years, the Centers for Medicare & Medicaid Services (CMS) have reported hospital quality measures on the Hospital Compare website, providing the public with a way to compare hospital performance. Hospital ...

No evidence of 'gaming' after death rates for bowel surgeons published

May 2, 2018
There is no evidence that publishing patient death rates for individual bowel surgeons in England has led to risk averse behaviour or 'gaming' of data, finds a study published by The BMJ today.

Mandatory public reporting of coronary artery bypass grafting associated with better patient outcomes

April 30, 2018
Mandatory public reporting of coronary artery bypass grafting (CABG) results in Massachusetts was associated with better patient outcomes compared to national findings, according to a recent study. Results of the 13-year ...

Public outcomes reporting tied to lower PCI rates for acute MI

March 20, 2015
(HealthDay)—Public reporting of outcomes may be tied to lower rates of percutaneous revascularization and higher in-hospital mortality among acute myocardial infarction (AMI) patients in reporting states, compared to nonreporting ...

Survival benefit seen for some patients when cardiologists are away at academic conferences

March 9, 2018
Heart attacks don't happen on a schedule. So how do patients fare if they suffer a heart attack while many cardiologists are away at academic meetings or research conferences?

Recommended for you

New China and US studies back use of pulse oximeters for assessing blood pressure

November 21, 2018
Fast and easy blood pressure monitoring could soon be at your fingertips—literally—thanks to new University of British Columbia research that showed BP can be assessed by a fingertip oximeter, a tool not generally used ...

Gut protein mutations shield against spikes in glucose

November 20, 2018
Why is it that, despite consuming the same number of calories, sodium and sugar, some people face little risk of diabetes or obesity while others are at higher risk? A new study by investigators at Brigham and Women's Hospital ...

Proteins cooperate to break up energy structures in oxygen starved heart cells

November 19, 2018
During a heart attack, the supply of oxygen to heart cells is decreased. This reduced oxygen level, called hypoxia, causes the cell's powerhouses, the mitochondria, to fragment, impairing cell function and leading to heart ...

Bullying and violence at work increases the risk of cardiovascular disease

November 19, 2018
People who are bullied at work or experience violence at work are at higher risk of heart and brain blood vessel problems, including heart attacks and stroke, according to the largest prospective study to investigate the ...

Genetic analysis links obesity with diabetes, coronary artery disease

November 16, 2018
A Cleveland Clinic genetic analysis has found that obesity itself, not just the adverse health effects associated with it, significantly increases the risk of Type 2 diabetes and coronary artery disease. The paper was published ...

Non-coding genetic variant could improve key vascular functions

November 15, 2018
Atherosclerotic disease, the slow and silent hardening and narrowing of the arteries, is a leading cause of mortality worldwide. It is responsible for more than 15 million deaths each year, including an estimated 610,000 ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.