How many patients really use quality report cards?

In 1996, a group of Pennsylvania researchers tested the popular assumption that if we compile report cards, patients will read them. The study1 centered on awareness of, interest in, and barriers to the use of Pennsylvania's Consumer Guide to Coronary Artery Bypass Graft (CABG) Surgery.

Published since 1992, the guide features risk-adjusted mortality ratings of all cardiac surgeons and hospitals in the state. The Pennsylvania Health Care Cost Containment Council compiles the material and disseminates it to hospitals, surgeons, public libraries, business groups, legislators, and the media. Individuals receive free copies upon request.

The study involved a sample of 474 patients who had undergone CABG surgery during the previous year. Investigators explored awareness, knowledge, use, and barriers to use of the guide. Here are the highlights of their findings:

    1. Awareness, knowledge and use of Consumer Guide.

    4 12% were aware prior to surgery.

    4 4% knew their hospital's ratings.

    4 2% knew their surgeon's or surgical group's ratings.

    4 1% reported that the surgeon's or surgical group's rating influenced their choice of same.

    2. Declared interest in obtaining Consumer Guide.

    4 28% not at all interested.

    4 22% somewhat interested.

    4 33% very interested.

    3. Willingness to change surgeons based on ratings.

    4 16% don't know.

    4 11% definitely would not change.

    4 31% definitely would change.

    4. Patient-reported barriers to use of performance ratings.

    4 38% had less than three days between decision to operate and surgery.

    4 33% had no other hospital within a reasonable distance.

    4 88% cited hospital proximity as "somewhat" or "very important" to the choice.

    4 43% remained in same hospital between the decision to operate and the operation.

The investigators comment that lack of awareness and use of the guide could stem from the fact that referring physicians are a prime source of information about the quality of surgical specialists. Other surveys reveal that Americans rely more on reports from relatives and friends than reports from objective sources.2

The researchers concede that one limitation of the study is its focus on a consumer information source seen by so few of the subjects. Even so, they note, "We found formidable evidence that public reporting of mortality outcomes in Pennsylvania has had virtually no direct impact on patients' selection of hospitals or surgeons."


1. Schneider EO, Epstein AM. Use of public performance reports: A survey of patients undergoing cardiac surgery. JAMA 1998; 279:1,638-1,642.

2. Robinson S, Brodie M. Understanding the quality challenge for health consumers: The Kaiser/AHCPR survey. Jt Comm J Qual Improv 1997; 29:239-244.