Public Outcomes Reporting Linked To Risk Aversion Of Sicker Patients Interview with:
Stephen W. Waldo, MD
Research Fellow in Medicine
Massachusetts General Hospital

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Waldo: Public reporting is intended to improve outcomes for our patients.  Proponents of public reporting applaud the increased transparency that it offers, allowing both patients and physicians to objectively evaluate health care outcomes for a given institution or individual provider.  Previous research has demonstrated, however, that public reporting of procedural outcomes may create disincentives to provide percutaneous coronary intervention for critically ill patients.  The present study sought to evaluate the association between public reporting of outcomes with procedural management and clinical outcomes among patients with acute myocardial infarction.  As the data demonstrate, public reporting of outcomes is associated with a lower rate of percutaneous revascularization and increased overall in-hospital mortality among patients with an acute myocardial infarction, particularly among those that do not receive percutaneous intervention.  This may reflect risk aversion among physicians in states that participate in public reporting, an unintended consequence of this policy.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Waldo: Public reporting of outcomes for percutaneous revascularization should balance the benefits of transparency and accountability against the potential for physician risk aversion.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Waldo: Future studies should seek to better understand risk aversion among physicians and investigate alternative public reporting systems that maintain transparency while also ensuring optimal patient outcomes.  Perhaps changes to the public reporting system that have already been employed in some jurisdictions – censoring of high risk patients with cardiac arrest or cardiogenic shock – will reduce risk aversion and improve patient outcomes.


 [wysija_form id=”2″] Interview with: Stephen W. Waldo, MD (2015). Public Outcomes Reporting Linked To Risk Aversion Of Sicker Patients