Influence of cardiac surgeon report cards on patient referral by cardiologists in New York State after 20 years of public reporting

Background-Report cards of risk-adjusted mortality rates of individual cardiac surgeons have been publicly available in New York State since 1991. A survey of New York cardiologists in 1996 found that these report cards had little effect on their referral recommendations to cardiac surgeons. It is unknown whether the influence of report cards on referral behavior has changed over time. Methods and Results-We surveyed cardiologists in New York State in 2011 to determine their awareness of cardiac surgeon report cards, their use of the report card in formulating judgments about the quality of cardiac surgeons and selecting cardiac surgeons for referral of patients, and discussion of the report with patients in need of cardiac surgery. The relation between demographic (age, sex) and professional (teaching, board certification, faculty appointment, general cardiology practice, and hospital employee) characteristics and the influence of report cards on referral decisions was assessed using χ2 for categorical variables and t test for continuous variables. Multivariable logistic regression models were created to determine the independent association of any variable with P<0.1 on univariate analysis. Almost all (94%) cardiologists were aware of report cards of cardiac surgeons. The influence of the report cards on cardiologists' referral decisions was limited, with 25% of cardiologists reporting a moderate or substantial influence on referral decisions. The report card was not discussed with any patients by 71% of cardiologists. The mean age of cardiologists reporting moderate or substantial influence of report cards was 58 years compared with 54 years for those who reported no/little influence (P=0.012). Fewer cardiologists who reported moderate or substantial influence were board certified (91% versus 99%; P=0.003). On multivariate analysis, general cardiology practice and employment by a hospital were independently associated with greater report card influence (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; P=0.13). Conclusions-After 20 years of public reporting and almost universal awareness of cardiac surgeon report cards, in 2011, cardiologists in New York State made little use of this information and rarely discussed it with patients at the time of referral for cardiac surgery.