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(Circulation. 2005;111:1257-1263.)
© 2005 American Heart Association, Inc.

Health Services and Outcomes Research

Racial Profiling

The Unintended Consequences of Coronary Artery Bypass Graft Report Cards

Rachel M. Werner, MD, PhD; David A. Asch, MD, MBA; Daniel Polsky, PhD

From the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pa: Division of General Internal Medicine, University of Pennsylvania School of Medicine; Leonard Davis Institute of Health Economics, University of Pennsylvania; and Department of Health Care Systems, the Wharton School, University of Pennsylvania, Philadelphia, Pa.

Correspondence to Rachel M. Werner, MD, PhD, Division of General Internal Medicine, University of Pennsylvania, 1208 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104. E-mail rwerner{at}wharton.upenn.edu

Received September 23, 2004; revision received December 19, 2004; accepted December 27, 2004.

Background— Although public release of quality information through report cards is intended to improve health care, there may be unintended consequences of report cards, such as physicians avoiding high-risk patients to improve their ratings. If physicians believe that racial and ethnic minorities are at higher risk for poor outcomes, report cards could worsen existing racial and ethnic disparities in health care.

Methods and Results— To investigate the impact of New York’s CABG report card on racial and ethnic disparities in cardiac care, we estimated differences in the use of CABG, PTCA, and cardiac catheterization between white versus black and Hispanic patients hospitalized for acute myocardial infarction in New York before and after New York’s first CABG report card was released, adjusting for patient and hospital characteristics and national changes in racial and ethnic disparities in cardiac care. The racial and ethnic disparity in CABG use significantly increased in New York immediately after New York’s CABG report card was released, whereas disparities did not change significantly in the comparison states. There was no differential change in racial and ethnic disparities between New York and the comparison states in the use of cardiac catheterization or PTCA after the CABG report card was released. Over time, this increase in racial and ethnic disparities decreased to levels similar to those before the release of report cards.

Conclusions— The release of CABG report cards in New York was associated with a widening of the disparity in CABG use between white versus black and Hispanic patients.

Key Words: ethnic groups • revascularization • myocardial infarction

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