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June 22/29, 2005

Publicly Reporting Quality Information

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor

JAMA. 2005;293(24):2999-3001. doi:10.1001/jama.293.24.2999-c

To the Editor: We believe that the Special Communication on publicly reporting quality information by Drs Werner and Asch1 incorporates a misleading presentation of the literature.

First, the study in which “patients undergoing bypass surgery in Pennsylvania and New York had lower illness severity than patients in states that did not publicly release the information . . . ”2 had a contrived design that used total hospital expenditures for any reason in the year prior to bypass surgery. The study by Hannan et al3 that they cited examines the issue in the correct way by looking at immediate preoperative severity of illness and changes in preoperative severity of illness over time. This study found that between 1994 and 1999, New York and Pennsylvania had greater increases in the percentages of (1) Medicare coronary artery bypass graft (CABG) patients who were 80 years of age and older and (2) patients who had a myocardial infarction or congestive heart failure at admission, than areas in the United States without formal quality improvement programs. Pennsylvania also had greater increases in the percentages of women and patients with 2 or more comorbid conditions undergoing CABG surgery, although the increases in New York were less than in the other areas. That study also found that the risk-adjusted odds of CABG mortality in New York and Pennsylvania relative to the other areas of the United States were 0.66 (95% confidence interval [CI], 0.57-0.77) and 0.79 (95% CI, 0.73-0.86), respectively.

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