Heart surgeon "report cards" often misinterpreted, from the Harvard Heart Letter

So-called report cards that rate individual heart surgeons on death and complication rates are now available on multiple government, insurance company, and commercial websites. But this information is not always presented in ways that are easy for people to understand and often leads to misinterpretation, reports the November 2012 Harvard Heart Letter.

Dr. Karen Donelan, a senior survey scientist from the Mongan Institute for Health Policy at Harvard-affiliated Massachusetts General Hospital, and colleagues created reports on several fictitious surgeons. The reports included information on the number of coronary artery bypass graft operations performed, the number and percentage of patients who died during or soon after the operation, and risk-adjusted mortality. The reports were presented in four different formats. How well volunteers were able to identify the "best" surgeon depended on how the information was presented. With the best format, 66% of those surveyed picked the best surgeon; with the worst, just 16% did.

Many people focused on the number of deaths rather than on the more important number—risk-adjusted mortality. It takes into consideration the overall health of the surgeon's patients at the time of surgery. "Most tertiary care hospitals care for very sick people who are referred because they may be too complicated for a community hospital to handle. Sicker patients are at higher risk for poor surgical outcomes," says Dr. Donelan. Looking at mortality rates that do not adjust for these risks may scare people away from outstanding surgeons who often operate on the sickest people.

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