CORRESPONDENCE: LETTER TO THE EDITOR
The Big Chill: Adverse Effects of Public Reporting on Access to Health Care
Craig R. Smith, MD*
* Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Avenue, MHB 7GN-435, New York, New York 10032 (Email: crs2{at}columbia.edu).
When asked by a national news organization to review and comment on the study published in JACC by Moscucci et al. (1), I had occasion to read the accompanying editorial by Turi (2). Dr. Turi, wrapping up an otherwise lucid and well-reasoned editorial, devotes a paragraph highlighting his own heroism in managing high-risk patients, then makes the following statement: "The public, even the well-informed public, frequently ignores published statistics, perhaps best demonstrated by former President Clinton’s recent cardiac catheterization and coronary artery bypass graft surgery (CABG). These procedures were performed in the only two hospitals in New York State that had risk-adjusted death rates significantly higher than the statewide average.
Risk-adjusted CABG mortality at Columbia Presbyterian has never, ever been "significantly" higher than the statewide average. Because we are referring to an average, let us agree not to be surprised that roughly one-half the hospitals in New York State have risk-adjusted CABG mortality that is "higher than the statewide average," and about one-half the hospitals are lower than the statewide average. Individual hospitals commonly fluctuate above and below the average from one reporting cycle to the next, which has been true for Columbia Presbyterian. In the most recent reporting cycle, three hospitals had risk-adjusted CABG mortality that was "significantly" higher than the statewide average, defined as falling outside the 95% confidence limits. I reiterate, Columbia Presbyterian was not one of these statistical outliers, and has never been one of them. Dr. Turi and the editorial board of JACC are certainly sophisticated enough not to be excused for tossing around the term "significantly" when not referring to a statistically significant difference. Never mind the questionable taste employed when dragging an individual patient into print to score points, just as Larry Altman did in the New York Times article that Dr. Turi cites (inaccurately) to support his argument.
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References
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- Moscucci M, Eagle KA, Share D, et al. Public reporting and case selection for percutaneous coronary interventions J Am Coll Cardiol 2005;45:1759-1765.[Abstract/Free Full Text]
- Turi ZG. The big chill. The deleterious effects of public reporting on access to health care for the sickest patients J Am Coll Cardiol 2005;45:1766-1768.[Free Full Text]
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