New York state is considered the "gold standard" for report cards on the medical quality of a certain heart surgery. For the past 15 years, the state department of health has issued report cards on hospitals and surgeons that perform coronary artery bypass surgery.
The report card is available to the public, yet a study in the journal Health Affairs finds the public doesn't pay much attention.
Dr. Ashish Jha and colleagues at Harvard School of Public Health looked at hospital death rates related to heart bypass surgery at 33 hospitals in the state, as well as the 168 surgeons who performed those surgeries.
They used publicly available data from the New York State Department of Health. These annual reports provide data on mortality rates and number of cases both by a hospital in a given year and by surgeon over a three-year period.
The reports typically become available one to three years after the observation period. Therefore, researchers wanted to know whether this information is useful to patients even though its available a number of years after the fact.
"We found that if patients use these report cards, that, by picking the 'best' hospitals and 'best' surgeons, they can cut their risk of dying from cardiac surgery in half," says Jha. "That's a pretty dramatically useful thing."
One would think patients contemplating serious heart surgery would seek out information about the success or failure of hospitals and surgeons that perform heart bypass surgery.
That's what Jha thought, too. But that turned out not to be the case.
"The notion," Jha says, "was that the really good hospitals should see a bump in their volume, that patients would start going there more often. We found none of that."
He says there was no evidence that the rates of surgery went up at the good hospitals, or went down at the bad ones.
The report cards are available free from the New York state Department of Health by calling an 800 number or by going to the state's Web site.
The report card looks nothing like a school report card. It's not particularly complicated, but at 50 pages, it is long. It describes how health experts determined patient death rates related to bypass surgery performed at hospitals. And it lists all the hospitals and surgeons which performed them.
The report card is fairly simple and direct. But clearly, says Jha, for it to be useful to consumers, it has to get a lot more simple and direct.
"I think patients are still not used to using information like this to make decisions about medical care," Jha says. "Patients are quick to use Consumer Reports to pick a Toyota over a Chevy, but they just don't think about using comparative information to pick one surgeon over another or one hospital over another."
Jha suggests that using something similar to the magazine's format to rank the best and worst hospitals and doctors would increase consumer acceptance of report cards.
Joyce Dubow, with AARP, the lobby group for older Americans, couldn't agree more.
Although many people may just naturally go on the Internet, many other people are simply "not Internet savvy," Dubow says.
"They are not comfortable, don't have access, aren't health literate," she says. "We know that older people like one-on-one counseling."
Dubow says it's really up to state health officials to come up with creative ways to get these types of medical report cards to the people who need it, when they need it. And, she suggests other potentially creative avenues to "reach out" to consumers, including things like public-service announcements, consumer groups and health sections of newspapers.
Interestingly, Jha points to one group that did pay attention to the report cards: heart surgeons.
Those who were rated poorly and had the highest patient death rates were four times more likely to stop practicing within two years of a report coming out. They either retired or moved out of state.
Jha says the surgeons reported they did so "under pressure from the hospital or department chair."