Do cardiac surgery report cards reduce mortality? Assessing the evidence.

Provider report cards feature prominently in ongoing efforts to improve patient quality. A well-known example is the cardiac surgery report-card program started in New York, which publicly compares hospital and surgeon performance. Public report cards have been associated with decreases in cardiac surgery mortality, but there is substantial disagreement over the source(s) of the improvement. This article develops a conceptual framework to explain how report-card-related responses could result in lower mortality and reviews the evidence. Existing research shows that report cards have not greatly changed referral patterns. How much providers increased their quality of care and altered their selection of patients remains unresolved, and alternative explanations have not been well studied. Future research should expand the number of states and years covered and exploit the variation in institutional features to improve our understanding of the relationship between report cards and outcomes.