Abstract
There seems no good reason for doctors to work in secret. Individual users of healthcare and the community in general, which ultimately bears the cost, are perfectly entitled to know how their health services and health providers are performing. The promulgation of surgical report cards has been hailed by some as a liberating step in the right direction. This paper seeks to analyse, from a clinician’s perspective, the evolution and limitations of report cards. Ultimately, the importance of report cards will not be their immediate utility, which is minimal, but as a first step in a much wider and far more important debate about how we meaningfully measure the quality of health services and providers (including managers and bureaucrats), the likely cost of such an enterprise, how much we are willing and able to pay and how we reconcile the competing needs of information versus clinical and preventive care when all are competing for the same and inadequate pool of resources.
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References
Abdul-Hamid, A.R. & Mulley, G.P. 1999. Why do so few older people with aortic stenosis have valve replacement surgery? Age and Ageing 28: 261–64.
Adab, P., et al. 2002. Performance league tables: The NHS deserves better. British Medical Journal 324: 95–8.
Anderson, T. & Hart, G. 1988. An overview of Australian and New Zealand Critical Care Resources. In ANZICS Intensive Care Survey. Carlton: ANZICS Research Centre.
Australian Institute of Health and Welfare 2007. Labour force: Medical. Australian Government Publication. Available at: www.aihw.gov.au/labourforce/medical.cfm http://www.aihw.gov.au/labourforce/medical.cfm.
Bonow, R.O. 2005. The Cardiovascular State of the Union. Circulation 111: 1205–07.
Boseley, S., 2009. ‘Heart operation death rates fall after data published’. Guardian (UK). Available at: www.guardian.co.uk http://www.guardian.co.uk, 29 July, 2009.
Bouma, B.J. et al. 2001. Variability in treatment advice for elderly patients with aortic stenosis: A nationwide survey in the Netherlands. Heart 85: 196–201.
Canadian Health Services Research Foundation 2006. Myth: People use health system report cards to make decisions about their health. Mythbusters. Available at: http://www.chsrf.ca/mythbusters/html/myth23_e.php.
Care Quality Commission 2008. Heart Surgery in the UK: Survival Rates. http:/heartsurgery.cqc.org.uk/Survival.aspx.
Chambers, J. 2005. Aortic stenosis (editorial). British Medical Journal 330: 801–02.
Clarke, R. 1996. Outcome as a function of annual coronary bypass graft volume. Annals of Thoracic Surgery 61: 21–26.
Davies, G. 2005. Queensland Public Hospitals Commission of Inquiry. Final report available at: http://www.qphci.qld.gov.au.
Department of Health. 2004. The National Service Framework for Coronary Heart Disease: Winning the War on Heart Disease: Progress Report.
Department of Health. 2008. The Coronary Heart Disease National Service Framework: Progress Report.
Dranove, D., et al. 2003. Is more information better? The effects of report cards on health care providers. Journal of Political Economy 111: 555–85.
Edwards, M-B. & Taylor, K.M. 2003. Is 30-day mortality an adequate outcome statistic for patients considering heart valve replacement? Annals of Thoracic Surgery 76: 482–85.
EuroSCORE: http:/www.euroscore.org/calc.html.
Fung, C. et al. 2008. Systematic review: The evidence that publishing patient care performance data improves quality of care. Annals of Internal Medicine 148: 111–23.
Henderson, A. et al. 1997. Prospective study of outcome and cost in a major Australian Intensive Care Unit using the APACHE III severity of illness scoring and prediction tool. Clinical Intensive Care 8: 58–62.
Kalavrouziotis, D. et al. 2009. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is not appropriate for withholding surgery in high-risk patients with aortic stensis: a retrospective cohort study. Journal of Cardiothoracic Surgery 4: 32.
Knaus, W.A. et al. 1985. APACHE II: A severity of disease classification system. Critical Care Medicine 10: 818–29.
Knaus, W.A. et al. 1991. APACHE III Prognostic System: A risk prediction of hospital mortality for critically ill hospitalized patients. Chest 100: 1619–36.
Kojodjoj, P. et al. 2008 Outcomes of elderly patients aged 80 and over with symptomatic, severe aortic stenosis: Impact of patient’s choice of refusing aortic valve replacement on survival. Quarterly Journal of Medicine 101: 567–573.
Lindroos, M. et al. 1993. Prevalence of aortic valve abnormalities in the elderly. An echocardiography study of random population sample. Journal of the American College of Cardiology 21: 1220–25.
MacDonagh, O. 1958. The 19th Century revolution in government: A reappraisal. Historical Journal 1: 52–67.
Marasco, S.F.; Ibrahim, J.E. 2007. Is the reporting of an individual surgeon’s performance doing more harm that good? In S. Clarke and J. Oakley, (eds). Informed Consent and Clinical Accountability, pp. 200–01. Cambridge: Cambridge University Press.
MORI Poll 2007. Royal College Physicians London, November.
New York State Department of Health 2008. Adult Cardiac Surgery in New York State 2003–5.
Nilsson, J. et al. 2006. Comparison of 19 pre-operative risk stratification models in open-heart surgery. European Heart Journal 27: 867–74.
O’Neill, O. 2002. A Question of Trust. Cambridge: Cambridge University Press.
Pitches, D. 2003. How to make a silk purse from a sow’s ear — a comprehensive review of strategies to optimise data for corrupt managers and incompetent clinicians. British Medical Journal 327: 1436–39.
Schneider, E.C. & Epstein, A.M. 1998. Use of public performance reports: A survey of patients and surgery. Journal of the American Medical Association 279: 1638–42.
Smith, R. 2009. NHS targets may have led to 1200 deaths in Mid-Staffordshire. The Telegraph (London), March 17. http://www.telegraph.co.uk/health/healthnews.
Sorell, T. 2007. Safety, accountability and choice after the Bristol Inquiry. In S. Clarke and J. Oakley, eds. Informed Consent and Clinical Accountability, pp. 52–75. Cambridge: Cambridge University Press.
Vahanian, A. et al. 2006. Aortic stenosis. In J. Camm, T.F. Luscher and S. Serruys, eds. The ESC Textbook of Cardiovascular Medicine, pp. 626–32. Oxford: Blackwell Publishers.
Waley, A. 1938. The Analects of Confucius. London: Allen and Unwin.
Warrel, D.A., Cox, T.M., Frith, J.D., eds. 2003. Oxford Textbook of Medicine, vol 2. Oxford: Oxford University Press.
Waterworth, P.D. et al. 2008. Factors which influence the cardiac surgeon’s decision not to operate on patients referred for consideration of surgery. Journal of Cardiothoracic Surgery 3: 9.
Werner, R.M. et al. 2005. Racial profiling: The unintended consequences of CABG report cards. Circulation 111: 1257–63.
Werner, R.M. & Asch, D.A. 2007. Examining the link between publicly reporting healthcare quality and quality improvement. In S. Clarke and J. Oakley, eds. Informed Consent and Clinical Accountability, pp. 213–25. Cambridge: Cambridge University Press.
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Henderson, A. Surgical Report Cards. Monash Bioethics Review 28, 1–20 (2009). https://doi.org/10.1007/BF03351313
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DOI: https://doi.org/10.1007/BF03351313