Public Reporting and Case Selection in Congenital Heart Surgery: Signals From a Multicenter Observational Study.

Area of Science:

• Cardiovascular Surgery
• Public Health Policy
• Healthcare Quality Improvement

Background:

• Public reporting in congenital heart surgery aims for transparency and quality improvement.
• Potential unintended consequence: hospitals may avoid complex, high-risk cases.
• Assessing changes in case selection and outcomes is crucial.

Purpose of the Study:

• Examine the association between public reporting adoption and hospital performance.
• Evaluate changes in predicted probability of mortality as a measure of case-mix complexity.
• Understand the impact of public reporting on congenital heart surgery case selection and outcomes.

Main Methods:

• Utilized the Inpatient Essentials Database for congenital heart surgeries (2016-2019).
• Stratified surgeries into pre- and post-public reporting periods.
• Employed interrupted time-series analysis and generalized estimating equations to assess outcomes.
• Supplemented with observed/expected mortality analysis.

Main Results:

• Analyzed 16,401 surgeries from 18 centers; 9,409 before and 6,992 after public reporting.
• Unadjusted in-hospital mortality decreased by 35% post-reporting (P=0.002).
• This decrease was not significant after adjusting for case complexity (P=0.14).
• Predicted probability of mortality decreased significantly immediately after reporting (P=0.006), indicating case selection changes.

Conclusions:

• The impact of public reporting on congenital heart surgery mortality is complex.
• No change in risk-standardized mortality suggests quality did not improve.
• Lower unadjusted mortality reflects improved pre-reporting outcomes and selection of lower-risk cases post-reporting.