This requires a careful design of outcome measures to avoid the unintended consequence of either penalizing facilities or clinicians who take on more difficult cases or rewarding those who avoid certain high-risk patients requiring treatment. In this context, the writing committee did not believe it was necessary to reproduce existing National Quality Forum endorsed measures that are already available in the public realm on in-hospital and 30-day mortality rate after PCI. The writing committee also considered a potential measure of 30-day readmission after PCI, given reportedly high rates of readmission and recent interest in this outcome by payers and policymakers. As in the case of mortality rate, risk-adjusted measures of 30-day readmission after PCI have been developed, and we point interested readers toward those measures.21 23 4.2.4. Patient Surveys Patient survey data have been used to compare the care pro- vided across health systems and providers. For example, the Mended Hearts pilot program conducted surveys of patients 6 months after PCI, asking a range of questions: What type of procedure did you have?, Are you following your medica- tion regimen?, and What can be done to improve knowledge of medications? Medicare Health Outcome Surveys also have been administered, as have a NCQA-HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) and system-level survey. In addition, many individual hospital systems have developed and implemented diagnosis-related group-based postdischarge surveys. Such surveys might be appropriate for measuring certain outcomes, including subjec- tive functional status, symptoms, knowledge, and overall sat- isfaction with the care process. However, critics point out that such measures can be disproportionately weighted by items unrelated to care, including availability of channels on the hos- pital television, food menu choices, and parking convenience. In addition, standardized tools for symptom measurement and for patient subsets are generally lacking. 