Surgeon Scorecard Research Articles

PD17-01 INTERPRETATION OF A SURGEON SCORECARD BY THE GENERAL PUBLIC AND ITS EFFECT ON SURGEON SELECTION

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making II1 Apr 2016PD17-01 INTERPRETATION OF A SURGEON SCORECARD BY THE GENERAL PUBLIC AND ITS EFFECT ON SURGEON SELECTION Lucas Labine, Colby Dixon, Issac Palma, Gretchen Hoff, and Christopher Weight Lucas LabineLucas Labine More articles by this author , Colby DixonColby Dixon More articles by this author , Issac PalmaIssac Palma More articles by this author , Gretchen HoffGretchen Hoff More articles by this author , and Christopher WeightChristopher Weight More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1166AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In an effort to improve patient autonomy, several organizations publish online data on surgeon performance. One such organization is Pro-Publica, an independent nonprofit newsroom that publishes an online ′surgeon scorecard.′ This scorecard reports calculated death and complication rates for surgeons performing elective procedures including radical prostatectomy in Medicare patients. We wanted to understand how the general public would interpret this data and how it would impact patients' selection of surgeon. METHODS 265 adults at the Minnesota State Fair were asked to interpret a representative image from the Pro-Publica surgeon scorecard. Participants were told that a loved one had already scheduled cancer surgery with a surgeon they trusted. They were then shown a graphic with a dot representing the point estimate complication rate and a bar representing the 95% confidence interval (CI) of their surgeon. They were also shown a graphic with 13 other surgeons' point estimate complication rates, all of which fell within the CI of the index surgeon's complication rate. Another surgeon with a 0.5% lower point estimate but statistically equivalent complication rate to the first surgeon was indicated on the graphic. Participants were then asked if they would recommend switching surgeons after seeing this graphic. RESULTS The surveyed population was educated with 89% having attended or graduated from college (n=235). Median age of participants was 50 years (range 20-74) with 68% females (n=179). Participants were from 136 different zip codes predominantly in the upper Midwest. When presented with the graphic representing two surgeons with different point estimate complication rates falling within the same confidence interval, 124 or 46.8% (95% CI 41-53) of respondents would recommend switching surgeons based on this single graphic. CONCLUSIONS Nearly half of adults surveyed would recommend switching cancer surgeons for genitourinary malignancies based on a graphical representation of surgeons' complication rates even though there was no statistically significant difference between the two surgeons. This suggests that simplistic displays of complicated statistical data may lead to changes in medical decision-making based on random error of measurement instead of true differences in surgeon quality. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e399 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Lucas Labine More articles by this author Colby Dixon More articles by this author Issac Palma More articles by this author Gretchen Hoff More articles by this author Christopher Weight More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Interpretation of an online surgeon scorecard by the general public and its effect on adults changing cancer surgeons even when presented with complication rates that are statistically equivalent.

83 Background: Recently Pro-Publica, an independent, non-profit newsroom, created a surgeon scorecard. This scorecard reports calculated death and complication rates for surgeons performing elective procedures in Medicare patients, including radical prostatectomy. We wanted to understand how the general population would interpret these data and whether it would influence surgeon choice. Methods: 265 adults at the Minnesota State Fair were recruited to participate in a survey requiring interpretation of a representative output graphic from the Pro-Publica website surgeon scorecard ( https://projects.propublica.org/surgeons ). The complication point estimate and 95% confidence intervals (CI) of a hypothetical surgeon, with whom survey participants were to assume that cancer surgery was already scheduled, were presented. They were also shown a graphic with 13 other surgeons point-estimate, complication rates, all of which fell within the index surgeon’s complication rate CI. Another surgeon, with a 0.6% lower point estimate, but statistically equivalent complication rate to the first surgeon, was indicated on the graphic. Participants were asked, based on this graphic alone, would they recommend switching surgeons? Results: The surveyed population was educated with 89% having attended, or graduated from college or higher (n = 235). Median age of participants was 50 years (Range 20-74). There were 179 females (68%) and 86 males (32%). Participants were from 136 different zip codes predominantly in the upper Midwest. 124 or 46.8% (95% CI 41-53) of respondents would recommend switching surgeons based on this single graphic. Conclusions: Nearly half of adults surveyed would recommend switching cancer surgeons for genitourinary malignancies based on data graphically presented on an online website, even though the point estimates between the two surgeons are not statically significantly different. This type of data display may lead to changes in medical decision-making based on random error of measurement of true complication rates not true differences in surgeon quality.

Editorial Comment

The recent release by ProPublica—a nonprofit news organization—of the Surgeon Scorecard, including data on individual complication rates by thousands of surgeons has renewed public interest in surgical quality. 1 Wei S. Pierce O. Allen M. Surgeon Scorecard. https://projects.propublica.org/surgeons/Date: 2015 Google Scholar In the surgical community, many criticized the initiative as unscientific, sensationalist, and likely to dissuade providers from operating on poor, elderly, and unwell surgical candidates, potentially exacerbating existing disparities in access to care. 2 Mandrola J. Failing grade for ProPublica's Surgeon Scorecard. http://www.medscape.com/viewarticle/848517Date: 2015 Google Scholar , 3 Parks J. Why the Surgeon Scorecard is a journalistic low point for ProPublica. http://www.kevinmd.com/blog/2015/07/why-the-surgeon-scorecard-is-a-journalistic-low-point-for-propublica.htmlDate: 2015 Google Scholar Despite these issues, the study was widely shared and discussed. More than ever, surgeons are facing calls to account for the quality of their care.