HMOs, Heart Patients Failing To Use Data on Cardiology Outcomes

October 15, 2000
Cover Story
Margaret Mulligan

Experts have been predicting that clinical decisionmaking will soon be put back into the hands of cardiologists and their patients. Third parties, such as insurers and managed care administrators, will no longer be involved, experts say. Physicians and patients will peruse cost and outcomes data and then decide together where the patient should go for his or her cardiac treatment.

In fact, the Internet's rapid growth in popularity was supposed to hasten the arrival of that day because interactivity would allow physicians and patients to see vast amounts of data on costs and quality that were previously available only to a select few.

While the predictions from experts have not yet been fulfilled, there are countless sources of data on health care quality and outcomes, especially for cardiac procedures. But many of them, particularly publicly funded data, are either not used at all or are seriously underused by patients, physicians, managed care organizations (MCOs), and insurers. That is the conclusion of Lars C. Erickson, MD, MPH, a cardiologist and health services researcher in the department of cardiology at the Children's Hospital in Boston.

Erickson and his colleagues studied hospital admission information on more than 58,000 adults who underwent coronary artery bypass graft (CABG) surgery at cardiac surgical centers in New York State between 1993 and 1996. Fourteen hospitals with an average mortality rate of 2.1% were deemed low-mortality centers, while 17 with an average mortality rate of 3.2% were deemed high-mortality centers, according to Erickson's research, which was published in The Journal of the American Medical Association, April 19.

For his analysis, Erickson used hospital mortality rates drawn from federal census data and from New York's Cardiac Surgery Reporting System (CSRS), a database established by the state ....

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