London hospital publishes mortality data for individual surgeons
http://www.100md.com
《英国医生杂志》
Another UK hospital, this time in London, has started publishing mortality data for operations performed by individual cardiothoracic surgeons.
At least two other hospitals—Manchester Heart Centre and Papworth Hospital in Cambridge—have taken this step, but St George抯 hospital, a teaching hospital, is the first in London to do so. The hospital posted the data on its website and has promised to supply similar information in the future for other surgical specialties.
Patient advocates gave the publication a guarded welcome. "We have said in the past that performance information hasn抰 been fine tuned enough for the individual patient who is debating whether to consent to a procedure and choose a hospital and a surgeon," said Frances Blunden, principal policy adviser for the consumers organisation Which?.
She added that a thorough explanation of the data should be seen as part and parcel of the informed consent procedure for individual patients. "Some consumers who are less able to work out what statistical risk means for them or who are vulnerable for other reasons must have the necessary support to help them through that decision," said Ms Blunden.
Her organisation would prefer to see a standardised approach, perhaps administered via the HealthCare Commission, which inspects NHS hospitals in England. In general, she warned, there was a danger that hospitals competing for patients would be tempted to manipulate data or turn away high risk cases.
The BMA shares some of these concerns. A BMA spokesperson agreed that patients should have high quality information. However, the BMA would oppose the use of crude mortality data. "Evidence from other countries shows that some surgeons are deterred from taking on very complex and therefore high risk procedures because published simplistic leagues tables count against them," the spokesperson said. "We are keen to work with the government and patients to develop meaningful and accurate data that will enhance patient choice."
St George抯 Hospital published raw data on mortality after coronary artery bypass graft, mitral valve replacement, and aortic valve replacement for the years 2002, 2003, and 2004. These data were pooled, and not attributed to individual surgeons.
Risk adjusted mortality after coronary artery bypass graft was also published for the same period. Complication rates for all cardiac surgery and for coronary artery bypass graft were released.
Risk adjusted mortality for all procedures was presented in a graph for the St George抯 Healthcare NHS Trust抯 five cardiac surgeons, named as individuals. All surgeons performed well, with no significant difference between them.
Consultant cardiac surgeon Robin Kanagasabay, one of the individual surgeons for whom mortality data were published, said: "We have had a very careful debate within St George抯 about this, and I and my colleagues think we have got the right balance in presenting information in a way which is understandable but which does not oversimplify."
The hospital抯 chief executive, Peter Homa, said: "We think we can go further. Cardiac surgery is on the leading edge of this debate, but surgeons from other specialties want to get involved too. There is no reason in principle why we shouldn抰 be publishing similar information right across all areas of surgery."(London Colleen Shannon)
At least two other hospitals—Manchester Heart Centre and Papworth Hospital in Cambridge—have taken this step, but St George抯 hospital, a teaching hospital, is the first in London to do so. The hospital posted the data on its website and has promised to supply similar information in the future for other surgical specialties.
Patient advocates gave the publication a guarded welcome. "We have said in the past that performance information hasn抰 been fine tuned enough for the individual patient who is debating whether to consent to a procedure and choose a hospital and a surgeon," said Frances Blunden, principal policy adviser for the consumers organisation Which?.
She added that a thorough explanation of the data should be seen as part and parcel of the informed consent procedure for individual patients. "Some consumers who are less able to work out what statistical risk means for them or who are vulnerable for other reasons must have the necessary support to help them through that decision," said Ms Blunden.
Her organisation would prefer to see a standardised approach, perhaps administered via the HealthCare Commission, which inspects NHS hospitals in England. In general, she warned, there was a danger that hospitals competing for patients would be tempted to manipulate data or turn away high risk cases.
The BMA shares some of these concerns. A BMA spokesperson agreed that patients should have high quality information. However, the BMA would oppose the use of crude mortality data. "Evidence from other countries shows that some surgeons are deterred from taking on very complex and therefore high risk procedures because published simplistic leagues tables count against them," the spokesperson said. "We are keen to work with the government and patients to develop meaningful and accurate data that will enhance patient choice."
St George抯 Hospital published raw data on mortality after coronary artery bypass graft, mitral valve replacement, and aortic valve replacement for the years 2002, 2003, and 2004. These data were pooled, and not attributed to individual surgeons.
Risk adjusted mortality after coronary artery bypass graft was also published for the same period. Complication rates for all cardiac surgery and for coronary artery bypass graft were released.
Risk adjusted mortality for all procedures was presented in a graph for the St George抯 Healthcare NHS Trust抯 five cardiac surgeons, named as individuals. All surgeons performed well, with no significant difference between them.
Consultant cardiac surgeon Robin Kanagasabay, one of the individual surgeons for whom mortality data were published, said: "We have had a very careful debate within St George抯 about this, and I and my colleagues think we have got the right balance in presenting information in a way which is understandable but which does not oversimplify."
The hospital抯 chief executive, Peter Homa, said: "We think we can go further. Cardiac surgery is on the leading edge of this debate, but surgeons from other specialties want to get involved too. There is no reason in principle why we shouldn抰 be publishing similar information right across all areas of surgery."(London Colleen Shannon)