The impact of publicly reporting risk-adjusted outcomes for hospitals and surgeons remains controversial, with particular concern about unintended consequences.
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.
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.
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).
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).
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).
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*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: email@example.com.
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