The Predictive Accuracy Of The New York State Coronary Artery Bypass Surgery Report-Card System

Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA.
Health Affairs (Impact Factor: 4.97). 05/2006; 25(3):844-55. DOI: 10.1377/hlthaff.25.3.844
Source: PubMed


We examined the impact of New York State's public reporting system for coronary artery bypass surgery fifteen years after its launch. We found that users who picked a top-performing hospital or surgeon from the latest available report had approximately half the chance of dying as did those who picked a hospital or surgeon from the bottom quartile. Nevertheless, performance was not associated with a subsequent change in market share. Surgeons with the highest mortality rates were much more likely than other surgeons to retire or leave practice after the release of each report card.

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    • "Most obviously physicians with higher quality training are expected to provide better care. In a study of coronary artery bypass surgery in New York, Jha and Epstein (2006) show that treatment by the 'best' physicians, as measured by riskadjusted mortality rates and volume, can reduce mortality in two common cardiac procedures by as much as 50%. In addition to providing better therapeutic care, more skilled physicians may have priority access to test results, operating rooms, and better nurses. "
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    ABSTRACT: Adverse health outcomes for uninsured patients have been attributed to their health status and to the quality of treatment received. A question about treatment that remains unexplored is whether physicians treating the uninsured are more likely to have characteristics indicative of lower quality than physicians treating insured patients. Using education, training, experience, and board certification to measure physician quality, we find that uninsured and Medicaid patients are treated by lower-quality physicians both because of the hospitals these patients attend and because of sorting within hospitals. The effects are statistically significant, but small.
    Inquiry: a journal of medical care organization, provision and financing 03/2010; 47(1):62-80. DOI:10.2307/23035597 · 0.55 Impact Factor
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    • "In studying how the New York CABG report card predicted performance and infl uenced consumer choice, Jha and Epstein (2006) concluded that the report cards did well in predicting the risk-adjusted mortality rates of hospitals and surgeons. In terms of the impact on the market, however, they reported mixed fi ndings. "
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    ABSTRACT: Despite the wide-ranging use of performance measures within the public sector and the growing use of performance bonuses to recognize performance achievements, the use of formal performance standards adjustment procedures in public performance measurement systems is relatively rare. Burt S. Barnow of Johns Hopkins University and Carolyn J. Heinrich of the University of Wisconsin-Madison set forth the basic arguments in favor of and against the use of formal or informal procedures for adjusting performance expectations. They describe how performance standards adjustments processes are currently (or have been) in use, review the evidence of their effectiveness or problems encountered in their application, and explore the consequences of the inadequacy of performance standards adjustments. The authors offer recommendations for the improvement of public sector performance measurement systems and conclude why this area remains fruitful for future research experimentation. The nice thing about standards is that there are so many of them to choose from. - Andrew S. Tannenbaum
    Public Administration Review 01/2010; 70(1). DOI:10.1111/j.1540-6210.2009.02111.x · 0.84 Impact Factor
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    • "However, they find no evidence that hospitals flagged as performing significantly above average attracted a greater number of patients. In contrast, Jha and Epstein (2006) argue that the data do not suggest any change in the market share of cardiac patients due to the NY Cardiac Surgery ratings. A further issue regarding whether or not rankings affect hospital-choice decisions is whether or not hospitals are operating at full capacity. "
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    ABSTRACT: Rankings and report cards have become a popular way of providing information in a variety of domains. I estimate the response to rankings in the hospital market and find that hospitals that improve their rank are able to attract significantly more patients. The average hospital in my sample experiences a 5% change in non-emergency, Medicare patient volume from year to year due to rank changes. These findings have implications regarding the competitiveness of hospital markets and the effect that the dissemination of quality information in hospital markets can have on individual choice.
    Journal of Health Economics 09/2009; 28(6):1154-65. DOI:10.1016/j.jhealeco.2009.08.006 · 2.58 Impact Factor
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