Evaluating outcomes in cardiac care and developing consensus for action: the Pennsylvania Health Care Cost Containment Council experience.

Sophisticated tools can be applied to patient data accurately reflecting patient severity of illness for individuals diagnosed with an acute myocardial infarction or undergoing coronary artery bypass graft surgery. These tools have been utilized in northern New England, New York, and Pennsylvania to assess the impact of care on outcomes for patients undergoing coronary revascularization for atherosclerotic heart disease. Results confirm there is wide variation in outcome associated with surgical volume and hospital processes. Traditionally, efforts to assess the clinical performance of individual physicians have been met by the profession with resistance. The Pennsylvania Health Care Cost Containment Council has recently undertaken an extensive analysis of patient outcomes for patients admitted to hospital with acute myocardial infarction in 1993. The process by which the Council developed consensus between business, labor, and the medical community to bring about this effort was noteworthy in its collaborative underpinnings and can serve as a model for public efforts to scrutinize health care outcomes.