University at Albany, State University of New York, 12144-3456, USA.
J Am Coll Cardiol. 2012 Jun 19;59(25):2309-16. doi: 10.1016/j.jacc.2011.12.051.
In 1988, the New York State Health Commissioner was confronted with hospital-level data demonstrating very large, multiple-year, interhospital variations in short-term mortality and complications for cardiac surgery. The concern with the extent to which these differences were due to variations in patients' pre-surgical severity of illness versus hospitals' quality of care led to the development of clinical registries for cardiac surgery in 1989 and for percutaneous coronary interventions in 1992 in New York. In 1990, the Department of Health released hospitals' risk-adjusted cardiac surgery mortality rates for the first time, and shortly thereafter, similar data were released for hospitals and physicians for percutaneous coronary interventions, cardiac valve surgery, and pediatric cardiac surgery (only hospital data). This practice is still ongoing. The purpose of this communication is to relate the history of this initiative, including changes or purported changes that have occurred since the public release of cardiac data. These changes include decreases in risk-adjusted mortality, cessation of cardiac surgery in New York by low-volume and high-mortality surgeons, out-of-state referral or avoidance of cardiac surgery/angioplasty for high-risk patients, alteration of contracting choices by insurance companies, and modifications in market share of cardiac hospitals. Evidence related to these impacts is reviewed and critiqued. This communication also includes a summary of numerous studies that used New York's cardiac registries to examine a variety of policy issues regarding the choice and use of cardiac procedures, the comparative effectiveness of competing treatment options, and the examination of the relationship among processes, structures, and outcomes of cardiac care.
1988 年，纽约州卫生专员面临医院层面的数据，这些数据表明心脏手术的短期死亡率和并发症存在巨大的、多年的、医院间的差异。人们关注的是，这些差异在多大程度上是由于患者术前疾病严重程度的差异，以及医院的护理质量的差异。这导致了 1989 年心脏手术和 1992 年经皮冠状动脉介入术的临床注册的发展。1990 年，卫生署首次公布了医院风险调整后的心脏手术死亡率，此后不久，类似的数据也公布了医院和医生的经皮冠状动脉介入术、心脏瓣膜手术和儿科心脏手术（仅医院数据）。这种做法仍在继续。本通讯的目的是介绍这一举措的历史，包括自心脏数据公开以来发生的变化或据称的变化。这些变化包括风险调整死亡率的下降、低容量和高死亡率的外科医生停止在纽约进行心脏手术、高危患者转诊或避免心脏手术/血管成形术、保险公司改变合同选择，以及心脏医院市场份额的改变。对这些影响的证据进行了审查和批评。本通讯还包括许多研究的摘要，这些研究利用纽约的心脏登记来研究与心脏手术的选择和使用、竞争治疗方案的比较效果、以及心脏护理过程、结构和结果之间的关系有关的各种政策问题。
