Cardiac Surgery: "Cardiac surgeons pioneered the development and use of outcome measures more than three decades ago." The Veterans Administration started it off in 1972 with a ‘multihospital database’ of unadjusted mortality rates for cardiac surgery. Then there were other players, but in 1989, the Society of Thoracic Surgeons (STS, www.sts.org) developed risk-adjusted measures and "began collecting voluntary adult cardiac surgery data and compiled a national risk-adjusted database."

Then the New York Department of Health required similar risk-adjusted outcomes reporting for coronary artery bypass graft (CABG) procedures. Independent cardiothoracic surgeons came up with these measures. "In the first four years of New York’s reporting program, death from cardiac surgery fell by 41%."

Other states (New Jersey, Pennsylvania, and California are listed in the Book) followed suit with similar results. I guess my question is: How can anybody argue against these results? What – it’s better to have more dead people than have outcomes published??!!!! Pa-leaze! But it seems that only the Cleveland Clinic publishes its "outcomes with comparisons to the national averages" – all others are blinded (i.e., not listed by facility).

But the movement continues. STS has been working on their system, adding measurements and working with the National Quality Forum (NQF) to develop a set of nationally accepted cardiac measurements.

NQF is a DC nonprofit whose mission is: "to improve the quality of American healthcare by setting national priorities and goals for performance improvement, endorsing national consensus standards for measuring and publicly reporting on performance, and promoting the attainment of national goals through education and outreach programs." You can find more information on NQF’s website: www.qualityforum.org.  

Even some health plan providers see the value of publishing risk-adjusted outcomes for medical conditions. "Starting in the 1990s, a number of health plans, including several Blue Cross Blue Shield affiliates, made participation in the database a criterion for being included in their preferred provider list."