The Impact of Public Reporting on Procedural Outcomes Following Congenital Heart Surgery - PROJECT SUMMARY/ABSTRACT Natalie Jayaram, MD MSB is an Assistant Professor of Pediatrics at the University of Missouri-Kansas City and a faculty member in the Department of Pediatrics and Division of Cardiology at Children’s Mercy Hospital in Kansas City, Missouri. As a pediatric cardiologist and health services researcher, her long-term career goals are to improve the care of pediatric patients with congenital heart disease (CHD) by contributing to the science of quality assessment, by examining the effectiveness of policy-based initiatives on care, and by partnering directly with patients to facilitate changes in care. The goal of the current project is to study public reporting for congenital heart surgery (CHS). Public reporting is designed to provide healthcare consumers with outcome data for a given provider or institution. Proponents of public reporting advocate for transparent disclosure of health outcomes data and contend that public reporting results in improved outcomes.1-4 Critics of public reporting cite evidence that public reporting may not substantially improve outcomes and could result in unintended consequences, including risk avoidance practices.5-14 Formal study regarding the impact of public reporting on outcomes for CHS has never been performed. The highly specialized nature of CHD care, with relatively less local or regional competition compared to more prevalent conditions (e.g. adult cardiovascular disease) but with patients willing to travel to seek the ‘best’ care,15 suggest that public reporting for CHS warrants independent investigation. The primary aims of the proposed project are: 1) to evaluate whether, as an unintended consequence of public reporting, there is a shift in patient case mix, suggesting that centers could be avoiding surgical intervention in patients at highest risk for poor outcome 2) to evaluate the association between implementation of public reporting for CHS and surgical outcomes, and 3) to better understand the type and format of data that CHD patients and families would find most meaningful to help them make informed decisions regarding care. Study aims 1 and 2 of the project propose obtaining data from the State Inpatient Database in order to study the association between public reporting, institutional case mix, and surgical outcomes at centers throughout the US performing CHS. Study Aim 3 proposes focus groups involving CHD patients and caregivers to gain an improved understanding of their preferences with regards to public reporting. Together with her mentorship team, Dr. Jayaram has worked to create a career development plan that will provide her with additional training, education, and experience in the areas of advanced statistical methodology, experience in working with administrative data, and formal training in qualitative research and patient engagement. Overall, the skills learned from this project and educational plan coupled with an outstanding mentorship team will allow Dr. Jayaram to achieve her ultimate goal of becoming an independent investigator and leader in the field of pediatric cardiovascular outcomes research.
