Report cards and quality: Do center report cards predict quality or simply predict the next report card?

摘要

1 read with great interest the recent elegant analysis by Schold et al (1) where the authors convincingly demonstrate that center report cards (specifically Scientific Registry of Transplant Recipients [SRTR] Program-Specific Reports) correlate fairly well to subsequent report cards. This is, in itself, an important and constructive finding as it informs centers, policy makers and patients that a centers outcome as defined by the current risk adjustment model is likely to correlate to subsequent proximate centers outcome. However, I am quite concerned that this analysis may be interpreted that report cards are also a consistent indicator of quality from one reporting period to another. As Hippen (2) points out in his editorial, quality is not equivalent to adjusted outcome measurements. Thus, the study does little to inform us if quality from one period predicts quality in the proximate future. This is not a trivial issue, nor is it a purely semantic issue. The precision of our insights is dependent on our precision in the words we use. Therefore, the potential for confusion of any message in this area is highly prone to miscommunication and misinterpretation. In fact, even these extraordinarily astute and accomplished authors seem to offer arguments that seem to use quality in what at first glance seem to be contradictory ways.