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January 13, 1999

Public Performance Reports for Cardiac Surgery—Reply

Author Affiliations

Margaret A.WinklerMDIndividualAuthorPhil B.FontanarosaMD, Senior EditorsIndividualAuthor

JAMA. 1999;281(2):135. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-2-jac80019

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 role.