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Ann Thorac Surg 2005;80:1146-1150
© 2005 The Society of Thoracic Surgeons

Review

Implementation of a Cardiac Surgery Report Card: Lessons From the Massachusetts Experience

David M. Shahian, MD a , * , David F. Torchiana, MD b , Sharon-Lise T. Normand, PhD c , d

a Department of Surgery, Caritas St. Elizabeth’s Medical Center Boston, Massachusetts USA
b Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts USA
c Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts USA
d Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts

* Address reprint requests to Dr Shahian, Department of Surgery, Caritas St. Elizabeth’s Medical Center, 736 Cambridge St, Boston, MA02135. (Email: david_shahian{at}cchcs.org).

Demand is increasing for public accountability in health care. In 2000, the Massachusetts legislature mandated a state report card for cardiac surgery and percutaneous coronary interventions. During the planning and implementation of this report card, a number of observations were made that may prove useful to other states faced with similar mandates. These include the necessity for constructive, nonadversarial collaboration between regulators, clinicians, and statisticians; the advantages of preemptive adoption of The Society of Thoracic Surgeons [STS] National Cardiac Database, preferably before a report card is mandated; the support and resources available to cardiac surgeons through the STS, the National Cardiac Database Committee, and the Duke Clinical Research Institute; the value of a state STS organization; and the importance of media education to facilitate fair and dispassionate press coverage. Some important features of report cards may vary from state to state depending on the legislative mandate, local preferences, and statistical expertise. These include the choice of a statistical model and analytical technique, national versus regional reference population, and whether individual surgeon profiling is required.


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