Among the 13 hospitals where bypass operations were performed, the ones meeting or exceeding the statewide average mortality rate of 3.75 deaths per 100 bypass surgeries tended to do a large number of the operations each year, usually more than 1,500, and the physicians who reached the average also were the busiest.
But state health officials and physicians cautioned patients not to depend on the report card exclusively when considering a hospital or doctor for bypass surgery, the most common surgery in the state.
They said the main effect of the report should be to spur hospitals and surgeons to make improvements, citing a fall in hospital mortality rates in New York and Pennsylvania following the regular publication of reports in those states.
``Do not pick a cardiac surgeon from this booklet,'' said Commissioner Len Fishman, of the state Department of Health and Senior Services. ``Use this to start a conversation with your doctor.''
The reports by all three states are part of a national trend toward measuring the quality of health and hospital care, spurred by market pressures from managed care firms and consumers who increasingly must choose from among many doctors and health plans.
``The patient really doesn't know how to assess the quality of physicians anymore,'' said Andrew Kunish, an official of the New Jersey Medical Society, the state's main group representing physicians. ``Now with people changing plans and the lack of a family doctor who follows the patient for 10 or 15 years, this [report card] helps people decide.''
Unlike the skeptical reception initially given to reports in New York and Pennsylvania, New Jersey's findings were received well by hospitals, surgeons and medical groups. Many credited New Jersey's health officials for taking into account the riskiness of each surgery, double-checking the results with hospital discharge records and audit reports, and letting each hospital check the facts to ensure accuracy before the release.
``This is an excellent tool,'' said Dr. Dale Edlin, president of the New Jersey chapter of the American College of Cardiology, which represents about 600 cardiologists in the state. ``The most important message for patients is to discuss these things with their doctors before making any decisions.''
Among the 48 doctors listed in the report, heart surgeon Lynn B. McGrath at Deborah Heart and Lung Center in Browns Mills, Burlington County, lost 19 patients in the two-year period from 687 bypass operations, known as coronary artery bypass graft surgery.
After accounting for 11 risk factors among the patients, the state gave McGrath a ``risk-adjusted mortality rate'' of 3.81 percent, statistically equal to the statewide average.
``Once you have this information, you need to ask, `How am I going to improve what I'm doing?' '' said McGrath, chairman of Cardiac Surgery at Deborah Heart and Lung Center. ``For example, are there things you could do to better prepare a person for surgery, such as getting the [kidney] dialysis as optimal as possible before surgery.''
New Jersey's report card checked for 11 risk factors, compared with seven in the latest Pennsylvania report. Among the risks were age, sex, history of heart disease and surgery, and the heart's ability to pump blood. McGrath said more variables could mean a more exacting measurement.
Fishman, the health commissioner, said it took health officials two years just to compile the report with 11 risk factors, and hoped that would be enough to earn a closer look by hospitals and surgeons.
``We enjoy a high quality of cardiac surgery, but there always is room for improvement,'' Fishman told reporters after presenting the report to a conference of cardiologists.
New York, for example, saw hospital mortality rates drop by 41 percent during the four years in which it released its annual reports, compared with 18 percent nationally, Fishman said. Pennsylvania's hospital mortality rate fell to 2.9 percent from 3.9 percent after publishing its report.
Some officials expressed concern that hospitals may start to turn away the ``sickest'' patients in hopes of maintaining their grades. Although Fishman, Edlin and other officials said they doubted New Jersey would face the problem, Cooper Hospital executive vice president Michael Dolfman said he was unsure.
``We're going to watch this,'' he said.
