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Medicine and Public Policy |

Scorecard Cardiovascular Medicine: Its Impact and Future Directions

Eric J. Topol, MD; and Robert M. Califf, MD
[+] Article and Author Information

From the Cleveland Clinic Foundation, Cleveland, Ohio; Duke University School of Medicine, Durham, North Carolina. Requests for Reprints: Eric J. Topol, MD, Department of Cardiology, Cleveland Clinic Foundation, Desk F25, 9500 Euclid Avenue, Cleveland, OH 44195. Acknowledgments: The authors thank Daniel Mark, MD, MPH; David Pryor, MD; and Edward Hannon, PhD, for their careful review and critique of the manuscript.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1994;120(1):65-70. doi:10.7326/0003-4819-120-1-199401010-00011
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Public release of operator-specific data for cardiovascular procedures has set a new precedent, introducing the “scorecard” era. Justification exists for public disclosure, but the mechanics of appropriate data release are complex from a clinical, statistical, and logistic standpoint. Scorecard medicine may appropriately promote regionalization of medical centers and consolidation of services, but unless the process is directed effectively, it may impair the development of new treatments because of a more restrictive clinical practice environment.

We propose revamping our current system to facilitate rapid and accurate access to outcome data in the local practice environment so that improvement in practice occurs on a voluntary basis rather than in response to punitive restrictions.A rational plan needs to be developed for dealing with high-risk patients, perhaps through compensation in regression models used to calculate expected outcomes, and for the start-up of novice physicians. Special provisions are needed to promote clinical research. Before procedures are done, it would be ideal to provide a full disclosure informed consent, whereby the physician reports operator-specific data and the patient's decision-making process is facilitated. Overall, appropriate implementation of scorecards could ultimately lead to a substantial improvement in the quality of U.S. cardiovascular medicine.

Figures

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Figure 1.
Risk-adjusted hospital mortality data for cardiac surgeons from New York State.[9]

Adopted from the Newsday, 9 December 1991 article, for all 140 cardiac surgeons doing coronary artery bypass surgery. Volume and mortality (mort.) are inversely related.

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