TABLE 2.

Comments from cardiac surgeons regarding public release of a coronary artery bypass graft surgery report card in Ontario

Positive comments
Public accountability and improvement in quality of care
One of the few accountability assessments in health care at present
Find nothing wrong with transparency
Public right to know and choose improved quality so surgeons cannot hide behind false impressions
I believe this may influence referral patterns in a positive way, will encourage self-assessment of surgeons practice
It can only improve care
Cardiac surgery is now a complacent specialty mired in the past. It needs a kick to get up to speed
They pay for the system equals their right
Negative comments
Stigma of an outlier label
Has potential detrimental effects that can be long-lasting even after issues have been corrected
Unfair propaganda. Good work is done by all institutions in Ontario (ie, good people are found everywhere)
Can be very misleading and would negatively influence practice
High-risk case avoidance
I will not do high risk-cases – who will?
You report results, I guarantee you high-risk patients will be treated with palliative medical therapy: A disaster!
It will lead to decreased patient access to surgery
Is it correct to have disincentives to perform surgery on patients with high-risk cardiac problems?
Are we denying people with a 70% to 90% chance of surviving because they have a 10% to 30% chance of death?
So what do we do, stop doing refusals if your statistics do not reflect this?
Accuracy of report card
Even though reports are ‘risk-adjusted’, I believe they may be misleading. Mortality is not the most important index
Not needed, the Canadian health care system has managed to do well without the option of choosing your health care provider at the specialty level
Certain institutions in Ontario have a long record of falsifying statistical data
Only statistics lie and this is grossly unfair to all health care providers
Misinterpretation by public, press and government
Insufficient education, understanding of statistics by press and lay public
Does the public understand the concept of ‘risk-adjusted’ versus crude rates?
General public do not understand reasons well enough to make them meaningful for them. It will confuse the average person…ie, Who is the better surgeon, surgeon with crude 0.4%, risk-adjusted 0.6% or one with crude 4%, risk-adjusted 2.5% mortality
Year-to-year variations and public interpretation are potentially misleading issues
It is more important for the surgeon and department to be aware and put in place ‘checks’ to improve quality. Lay people see only a percentage mortality and assume that is either good or bad without further understanding