Effects of report cards on referral patterns to cardiac surgeons

Area of Science:

• Health Services Research
• Medical Economics
• Public Health Policy

Background:

• Patient choice of specialist physicians is influenced by referring physicians and public performance reports.
• Cardiac surgery report cards aim to improve transparency and guide patient and physician decisions.
• The impact of publicly available performance data on referral patterns remains an area of investigation.

Purpose of the Study:

• To evaluate whether the publication of Pennsylvania's Coronary Artery Bypass Graft (CABG) Surgery report card in May 2002 altered referral patterns to cardiac surgeons.
• To determine if the report card provided new information beyond what referring physicians already knew about surgeon performance.

Main Methods:

• A counterfactual research design was employed, creating a simulated report card using comparable data from Florida, a state without such report cards.
• Referral patterns to both low-mortality and high-mortality cardiac surgeons were analyzed before and after the report card's publication.
• Statistical analysis was conducted to detect significant changes in referral trends.

Main Results:

• The study found no significant change in referral patterns to cardiac surgeons, regardless of their mortality rates, following the report card's release.
• Referring physicians demonstrated a baseline understanding of cardiac surgeon performance, even without the aid of report cards.
• The analysis suggests that existing referral patterns may already reflect quality signals.

Conclusions:

• Publication of the Pennsylvania CABG report card did not significantly alter physician referral practices.
• Referring physicians possess substantial knowledge regarding cardiac surgeon quality, independent of formal report cards.
• Future healthcare report card initiatives could be enhanced by integrating and analyzing the information embedded within established referral patterns.