Ethical issues related to cardiac report cards.

Health care report cards are gaining a high profile among policy makers, clinicians and the public, and are most well developed in the context of cardiac care. Although there are important ethical issues relevant to developing and implementing cardiac report cards, there currently is no explicit examination of these issues. As a consequence, outcomes researchers lack ethical guidance while designing and implementing cardiac report cards. This paper will examine four key ethical issues related to cardiac report cards: quality, informed consent, equity and legitimacy. Cardiac report cards may help improve the quality of cardiac care, help cardiac patients make informed decisions and guide interventions to enhance regional equity in cardiac care. To achieve these important goals, different types of report cards may be required. However, to achieve these goals, cardiac report cards must be legitimate. To push forward the report card initiative, a close relationship among stakeholders is encouraged, ie, among those developing cardiac report cards, those whom report cards evaluate and the intended audiences of report cards.