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Public Reporting in Cardiovascular Medicine: Accountability, Unintended Consequences, and Promise for Improvement

“The Trustees of Hospitals should see to it,” wrote Dr Ernest Amory Codman in 1918, “that an effort is made to follow up each patient they treat, long enough to determine whether the treatment given has permanently relieved the condition or symptoms complained of.”1

These views did not help Dr Codman’s career. He quit his position as a staff surgeon at the Massachusetts General Hospital to protest the hospital administration’s refusal to measure and disclose outcomes and was later forced to resign as chairman of the Suffolk District Surgical Society.2 Two weeks after his death in 1940, the hospital’s trustees passed a resolution calling him a “champion of truth” who was “willing to sacrifice personal place and standing to achieve what he believed to be right.”2 In poor financial circumstances, he was buried initially without a headstone. In 2014, Dr Andrew L. Warshaw, the surgeon-in-chief emeritus and a former president of the New England Surgical Society, organized a granite and bronze memorial for Dr Codman’s gravesite in Cambridge, MA.2

More than 7 decades after Dr Codman’s death, debate persists about how to measure and report outcomes in medicine. Although the concept of measuring outcomes is now firmly embraced, risk-adjustment methods, the dissemination of outcomes data, and the incentives for healthcare providers and healthcare systems to improve outcomes remain contested. Cardiologists and cardiac surgeons have been among the first physicians to grapple with these issues, largely because cardiac disease is appealing for outcomes measurement and reporting. Not only is cardiac disease the leading cause of death in the United States, accounting for nearly one-fifth of healthcare spending,3 but the cardiovascular community has led the way in evidence-based guidelines that lend themselves to quality measurement. Globally, ischemic heart disease and stroke have become the top 2 causes …