(Circulation. 1996;93:403-406.)
© 1996 American Heart Association, Inc.
Articles |
Operator-Specific Outcomes
A Call to Professional Responsibility
From the Department of Medicine, Duke University Medical Center, Durham, NC.
Correspondence to Robert M. Califf, MD, Professor of Medicine, Duke University Medical Center, 2024 W Main St, Durham, NC 27705.
Key Words: Editorials • clinical outcome • quality control
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Introduction |
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One of the fundamental changes in the transformation of medical practice involves the ability of large purchasers of health care to select among competing providers for health care services. Lacking sufficient information about quality and outcomes, decisions concerning provider selection are driven primarily by price considerations. In the progression to a managed care–dominated system, prices may be driven down to the point where the quality of care is at risk. Sufficient information about healthcare quality will become critical in maintaining an effective healthcare system. The article by Ellis and colleagues1 in this issue of Circulation raises the important question of what outcomes should be measured to assess the quality of percutaneous revascularization and, more importantly, what the potential limitations are of these measures.
The recent release of operator-specific outcomes data has
ushered in a new terminology known as "scorecard
medicine."2 3 The use of the term
"scorecard,"
although having some negative connotations, provides symbolic insight
into the issues that must be addressed by the profession. For decades
in this country, thousands of fans have carefully followed the
statistics of their favorite baseball players (without the benefits of
a postgraduate mathematics degree). Intuitive familiarity through years
of observation has led the public to widespread sophistication about
interpreting these statistics. Small differences in batting averages
early in the year are not regarded as important. Hitters with few
"at bats" are not considered to have stable estimates of their
hitting capabilities; a hitter with 3 hits in his first 10 at bats is
not
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