Public reporting of cardiac surgery outcomes should use risk-adjusted results based on clinical data.728 735 (Level of Evidence: B) See Online Data Supplement 31 for additional data on public reporting of cardiac surgery outcomes. To address the need for valid and reliable risk-adjusted outcomes data, cardiac surgery registries were developed by the STS,306,725,727 Veterans Administration,306,736 738 North- ern New England Cardiovascular Disease Study Group,739,740 and the state of New York.741,742 These have been the basis for several performance assessment and improvement strate- gies, including public report cards,742 744 confidential feed- back to participants showing their performance relative to national benchmarks,306,737,745 748 and state or regional col- Hillis et al 2011 ACCF/AHA CABG Guideline e685 laboratives that identify and disseminate best-practices infor- mation.749 Public report cards are the most controversial of these 3 approaches. Although they provide transparency and public accountability, it is unclear if they are the only or best way to improve quality. Reductions in the CABG mortality rate after the publication of such report cards in New York were encour- aging,742,750 752 but subsequent studies revealed comparable reductions in other states, regions, and countries that used confidential feedback with or without performance improvement initiatives.752 754 These findings suggest that the common de- nominator among successful performance improvement strate- gies is the implementation of a formal quality assessment and feedback program benchmarked against regional or national results.755 The incremental value of public (as opposed to confidential) reporting is controversial. 