MASSDEVICE ON CALL — Doctors at publicly reported hospitals may be negatively influenced by public reporting protocols, according to a presentation at last week’s Society for Cardiovascular Angiography & Intervention 2014 Scientific Sessions.
When doctors know that rates of admissions and deaths are reporting publicly, they may be less willing to take dramatic steps with emergency patients in order to avoid tying a death to an intervention.
Medscape reported that Massachusetts General Hospital’s Dr. Kenneth Rosenfield presented the audience with the case of a patient brought in for cardiac arrest, for whom efforts at resuscitation and shocks had restored heart rhythm. Physicians had then to determine whether to provide the patient with conservative care, take her to surgery to look for a blocked blood vessel, offer brain scans, or a number of other options.
Most doctors in the audience voted for percutaneous coronary intervention to look for a "culprit vessel" responsible for the cardiac arrest. Those doctors may choose differently if they were in reporting hospitals, Dr. Rosenfield maintained.
"What if your mortality this year is already high, compared with your peers?" Rosenfield said. "What if your hospital has already been identified as an outlier, with more PCI deaths than other hospitals? What if it had already undergone an external review."
Doctors at those types of institutions may begin to balance proactive care with maintaining the reputation of the hospital.
Certain elements of public reporting are valuable, Rosenfield said, but the system as it is now also discourages doctors from high-risk patients. Other doctors may choose to offer more interventions to patients that are highly likely to have good outcomes, in order to boost the hospital’s numbers, according to Medscape.
"Public reporting leads physicians to consider factors beyond the individual patient when making decisions regarding high-risk emergent procedures," Brigham and Women’s Hospital’s Dr. Frederic Resnic said.
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