Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts.
Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical, Harvard Medical School, Boston, Massachusetts.
JAMA Cardiol. 2018 Jul 1;3(7):635-640. doi: 10.1001/jamacardio.2018.0947.
More than 20 years have passed since public reporting of percutaneous coronary intervention (PCI) outcomes first began in New York State, but reporting remains a polarizing issue.
Advocates of public reporting point to the strong incentive that public disclosure of outcomes data provides for institutions and clinicians to improve clinical care and to the importance of enabling patients to make informed choices about their care. Critics highlight the methodological challenges that impede fair and accurate assessments of care quality as well as reporting's unintended consequences. Public reporting of PCI outcomes has only been implemented in 5 states, but reporting efforts for multiple conditions and procedures are now proliferating nationally, propelled by the notion that transparency improves the quality of health care and fosters trust in health care institutions. Careful evaluation of the evidence to date for PCI in particular, however, suggests that enthusiasm for such efforts should be tempered.
Public reporting has not achieved its primary objectives. Policy makers should consider variations of reporting that might strengthen care quality, empower patients, and mitigate undesirable repercussions.
自纽约州首次报告经皮冠状动脉介入治疗(PCI)结果以来,已经过去了 20 多年,但报告工作仍然存在争议。
提倡公开报告的人指出,公开披露结果数据为机构和临床医生提供了改善临床护理的强大动力,也强调了使患者能够就其护理做出明智选择的重要性。批评者强调了阻碍对护理质量进行公平和准确评估的方法学挑战,以及报告的意外后果。只有 5 个州实施了 PCI 结果的公开报告,但现在全国范围内正在对多种疾病和程序进行报告工作,这是基于透明度可以提高医疗保健质量并促进对医疗机构信任的观念。然而,对 PCI 迄今为止的证据进行仔细评估表明,应该缓和对这些努力的热情。
公开报告并未实现其主要目标。政策制定者应考虑报告的变化,这些变化可能会加强护理质量,增强患者的能力,并减轻不良影响。