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June 22/29, 2005

Publicly Reporting Quality Information—Reply

JAMA. 2005;293(24):2999-3001. doi:10.1001/jama.293.24.3000

In Reply: Drs Hannan and Chassin raise an important concern: the evidence regarding the role of publicly reporting quality information is unclear. It was that uncertainty that led us to write our report, and it is the same uncertainty that leads us to view this evidence in a different light. For example, while they criticize the method used by Dranove et al1 to assess patient severity (using prior year’s inpatient expenditures or prior year’s inpatient days), we find that method to be a clever way to measure illness severity using information available to the surgeon, but not used in the severity adjustment method of the report card. And what they describe as “a mere increase” of 35 patients transferred from New York to the Cleveland Clinic in the study by Omoigui et al2 can instead be described as a 57% increase, given that the base number of referrals was 61. While it is true that this study did include patients referred out of New York State before the release of information to the public, those patients might still be relevant because they were referred after surgeons were presumably aware that they were being evaluated. Any bias introduced by their sampling time frame would likely understate the conclusion that the Cleveland Clinic received an increase in the number of referrals of generally sicker patients from New York State after measurement of CABG outcomes began. This is precisely the finding one might expect if surgeons were trying to avoid sicker patients.

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