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Can Large-Scale Interventions Improve Care?

Stephen F. Jencks, MD
JAMA. 1997;277(5):419-420. doi:10.1001/jama.1997.03540290071034.
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The burgeoning outcomes measurement industry has generated growing attention to steps that governments and organizations can take to promote better outcomes. In an era of growing belief in market forces and disquiet with regulation, publishing information for consumers and providing technical assistance to providers have special appeal. A leader in the former has been New York State, which has published statewide information on mortality rates of coronary artery bypass graft (CABG) centers and surgeons. Three years ago, Hannan and colleagues1 reported that publication of performance had been followed by a 41% decrease in risk-adjusted CABG mortality rates in New York between 1987 and 1993. They argued that publication played a significant role in the decline. Last year, O'Connor and colleagues2 reported a 24% decrease in risk-adjusted mortality between 1987 and 1993 in the Northern New England Cardiovascular Disease Study Group, which is a voluntary quality improvement consortium of


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