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Impact of Public Reporting of Coronary Artery Bypass Graft Surgery Performance Data on Market Share, Mortality, and Patient Selection

Romano, Patrick S. MD, MPH*,†,‡; Marcin, James P. MD, MPH*,‡; Dai, Jian J. PhD§; Yang, Xiaowei D. PhD§; Kravitz, Richard L. MD, MSPH*,†; Rocke, David M. PhD§; Dharmar, Madan MBBS; Li, Zhongmin PhD

doi: 10.1097/MLR.0b013e3182358c78
Original Articles

Background: The impact of publicly reporting risk-adjusted outcomes for hospitals and surgeons remains controversial, with particular concern about unintended consequences.

Objectives: We evaluated the impact of 3 reports from the voluntary California CABG Mortality Reporting Program (CCMRP) on hospital market share, hospital mortality, and patient selection for coronary artery bypass graft (CABG) surgery.

Research Design and Participants: We analyzed data from January 2000 to December 2005 for all patients receiving isolated CABG surgery in California. We compared hospital groups based on their quality classification, including low-mortality outliers (“better”), high-mortality outliers (“worse”), and nonoutliers, as well as participation in the CCMRP.

Measures: We compared changes in market share, risk-adjusted mortality, and hospital caseload of high-risk patients for isolated CABG surgeries before and after the public release of 3 CCMRP reports (July 2001, August 2003, and February 2005).

Results: Low-mortality outlier hospitals experienced significantly increased market share for isolated CABG surgery in the first 6 months after the public release of the CCMRP reports (relative change in adjusted mean market share=8.9%, P=0.002). We found no evidence to suggest reduced risk adjusted mortality after the release of the CCMRP reports, but high-mortality outlier hospitals, on average, operated on less sick patients (relative change in mean expected mortality=25%, P=0.02).

Conclusions: The release of public CABG hospital performance reports in California was associated with increased volume at low-mortality hospitals, and may have reduced referrals of high-risk patients to high-mortality hospitals (or risk avoidance).

Supplemental Digital Content is available in the text.

*Center for Healthcare Policy and Research

Departments of Internal Medicine


§Public Health Sciences, UC Davis School of Medicine, Sacramento, CA

Disclosure of funding received for this work: Other (California Office of Statewide Health Planning and Development).

The authors declare no conflict of interest.

Reprints: James P. Marcin, MD, MPH, 2516 Stockton Blvd, Sacramento, CA 95817. E-mail:

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© 2011 Lippincott Williams & Wilkins, Inc.