Statistical and clinical aspects of hospital outcomes profilling

Hospital profiling involves a comparison of a health care provider's structure, processes of care, or outcomes to a. standard, often in the form of a report card. Given the ubiquity of report cards and similar consumer ratings in contemporary American culture, it is notable that these are a relatively recent phenomenon in health care. Prior to the 1986 release of Medicare hospital outcome data, little such information was publicly available. We review the historical evolution of hospital profiling with special emphasis on outcomes; present a detailed history of cardiac surgery report cards, the paradigm for modem provider profiling; discuss the potential unintended negative consequences of public report cards; and describe various statistical methodologies for quantifying the relative performance of cardiac surgery programs. Outstanding statistical issues are also described.