Public Hospital Reporting Reduces Angioplasties

Harvard School of Public Health researchers found that heart attack patients treated in hospitals in states with mandatory public reporting are less likely to receive angioplasties to fix heart blockages than those treated in states without public reporting.

Advocates of public reporting of hospital performance say that the practice gives patients more information to help them choose the best hospitals. Reporting may also give physicians incentives to improve their performance.

“Transparency is a good thing,” said Karyn E. Joynt, lead author of the study. “As a consumer, we all want to see what’s happening at our hospitals.

”The researchers analyzed data from Medicare patients older than 65 years of age who had suffered heart attacks in Massachusetts, New York, and Pennsylvania, three public reporting states, and compared them to those in seven non-reporting states.

The study, published in the Journal of the American Medical Association, is the first of its kind to look at public reporting for these procedures on a national scale.

Researchers were concerned, however, that public reporting might spur hospitals to change their practices. If hospitals are concerned about publishing negative data in reports, they may be less inclined to offer these interventions to very sick patients.

“We maybe need to think about ways to improve the policy so that we don’t have any unintended consequences,” said Joynt, an instructor in the Department of Health Policy and Management at the School of Public Health and a physician at Brigham and Women’s Hospital and VA Boston Healthcare System.

“My hope is that [this study] stimulates people to think about better ways to select patients for these procedures...and that it spurs a conversation about both overuse and underuse,” Joynt said.

Joynt said she hopes that states that are contemplating adopting reporting practices think through risk adjustment and exceptions for the sickest patients to make sure that their practices are as accurate and fair as possible.

“That’s a really hard decision to make,” she said. “It’s important to help the doctors in the future with the most research-driven data possible.”

—Staff writer Cynthia W. Shih can be reached at cshih@college.harvard.edu.