Abstract
Background: Public and private organizations have called for increased transparency in reporting of outcomes data for hospitals and surgeons, including risk-adjusted coronary artery bypass graft surgery (CABG) mortality data. Limited information is available about how the public actually interprets these data. Methods: Four different graphical and tabular displays of CABG outcomes for surgeons, three of which were modeled on current state public reports, were shown to 337 adults. Each display contained data for 3 to 5 hypothetical surgeons. For each format, respondents were asked to choose which surgeon they would be most and least likely to choose based on the data. Additionally, they were asked questions about public reporting. Results: Accurate identification of best surgeon performance varied by display format, with a high of 66% on one display and a low of 16% on another. Only 6.4% identified the surgeon with the lowest risk mortality across all four displays. Respondents with at least some college education were significantly more likely to identify the surgeon with the lowest risk-adjusted mortality, compared with respondents having no college education (21% to 72% vs. 9% to 59%; p < 0.01). In one display, the surgeon with the lowest risk-adjusted mortality was effectively penalized for taking on higher-risk patients; respondents tended to select the surgeon with the lowest-risk population but the highest risk-adjusted mortality. Overall, 82% of respondents said that access to these types of data would be "absolutely essential" or "very important" in choosing a surgeon. Conclusions: Comprehension by the public of risk-adjusted CABG outcomes is limited and varies by display format. Poorly constructed displays may have led to misinterpretation, with potential unintended adverse consequences such as risk aversion. Further work is needed to design displays that maximize accurate interpretation by the public and more clearly define the risk and benefit of public reporting of surgeon performance.