Wednesday, April 01, 2009

Could Hospital Rankings Hurt Patients?

There's now evidence hospital ranking schemes might adversely affect some patients:
"Recent studies in Massachusetts and nationally suggest that cardiologists may be turning away more high-risk patients as an unintended consequence of public reporting, Resnic said. In a paper published in the Journal of the American College of Cardiology last month, Resnic and his coauthors reported that in 2005, the proportion of patients undergoing angioplasty in Massachusetts for cardiogenic shock - a life-threatening condition caused by poor heart function - dropped to 1.3 percent, from 2.3 percent in 2003, the year the state began publicly reporting angioplasty death rates. Since then, the rate has been level, he said."


Keith Sarpolis said...

But did the incidence of cardiac death rise as a result?

You can look at the issue the way you are viewing it and assume less angioplasties means more people not being treated properly. The other possibility is that the procedure was being overutilized to begin with and the reduction has not resulted in any significant morbidity or mortality. We need to know if this drop in angioplasty rate caused any harm or not to the patients denied the procedure.

Do we assume that cardiologists are standing by refusing to perform a procedure that could save a patients life, and not doing so out of concern of what it will do to there performance statistics? That doesn't say much for the ethical practice of medicine now, does it?

DrWes said...

But did the incidence of cardiac death rise as a result?

We do not know the answer to your rhetorical question. While I understand your point, it is clear that the threat of a poor outcomes weighs heavier on doctors' decisions to intervene in complicated cases these days in states with such ranking systems. Might there a circumstance where a survivable patient that is left untreated because a host of other confounding clinical variables made the professional risk too great for the doctor? While I do not perform these procedures, I would argue it could happen and probably has - just because of the threat of generating poor performance statistics.