Margaret A.WinklerMDIndividualAuthorPhil B.FontanarosaMD, Senior EditorsIndividualAuthor
In Reply: We agree with Mr Volavka
that quality improvement in health care occurs via many paths.
Large-group purchasers, hospitals, and health plans are undoubtedly
playing a critical role. The Pennsylvania Health Care Cost Containment
Council's commitment to tackling the challenges of reporting outcomes
is meritorious, and the evidence of success he cites is impressive.
Our study focused on patients' use of the Pennsylvania Consumer
Guide to Coronary Artery Bypass Graft Surgery because it has been
among the best of pioneering efforts that report outcomes in a
consumer-friendly format. Federal and state policymakers have embraced
the notion that "report cards" can drive individual patient
decisions on the theory that improved decisions will drive improvements
in health care quality. While this concept has intuitive appeal, our
study found that individual patients were not yet prepared to play this
Schneider E, Epstein A. Public Performance Reports for Cardiac Surgery—Reply. JAMA. 1999;281(2):135. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-2-jac80019