Abstract
ObjectiveTo evaluate the impact of different dissemination channels on the awareness and usage of hospital performance reports among referring physicians, as well as the usefulness of such reports from the referring physicians’ perspective.Data sources/Study settingPrimary data collected from a survey with 277 referring physicians (response rate = 26.2%) in Nuremberg, Germany (03–06/2016).Study designCluster-randomised controlled trial at the practice level. Physician practices were randomly assigned to one of two conditions: (1) physicians in the control arm could become aware of the performance reports via mass media channels (Mass Media, {n}_{MM}^{pr} =132, {n}_{MM}^{ph} =147); (2) physicians in the intervention arm also received a printed version of the report via mail (Mass and Special Media, {n}_{MSM}^{pr} =117; {n}_{MSM}^{ph} =130).Principal findingsOverall, 68% of respondents recalled hospital performance reports and 21% used them for referral decisions. Physicians from the Mass and Special Media group were more likely to be aware of the performance reports (OR 4.16; 95% CI 2.16–8.00, p < .001) but not more likely to be influenced when referring patients into hospitals (OR 1.73; 95% CI 0.72–4.12, p > .05). On a 1 (very good) to 6 (insufficient) scale, the usefulness of the performance reports was rated 3.67 (±1.40). Aggregated presentation formats were rated more helpful than detailed hospital quality information.ConclusionsHospital quality reports have limited impact on referral practices. To increase the latter, concerns raised by referring physicians must be given more weight. Those principally refer to the underlying data, the design of the reports, and the lack of important information.
Highlights
The aim of public reporting is to improve healthcare quality by both stimulating quality improvement on the provider level (“Improvement Through Changes in Care”) and by helping patients and other consumers select the “right” provider (“Improvement Through Selection”) [1]
Surveys of cardiologists in Pennsylvania in 1996 [11] and New York in 1997 [12] have revealed that even though most cardiologists were aware of cardiac surgery report cards, the impact of these on their hospital referral
This study explores the impact of different dissemination channels on the awareness and usage of a hospital performance reporting initiative, namely the Nuremberg hospital quality reporting system (NHQRS), among referring physicians, as well as the usefulness of such reports from the referring physicians’ perspective
Summary
The aim of public reporting is to improve healthcare quality by both stimulating quality improvement on the provider level (“Improvement Through Changes in Care”) and by helping patients and other consumers select the “right” provider (“Improvement Through Selection”) [1]. The available international literature suggests a limited impact of publicly reported quality information on the hospital referral behavior of physicians. This study explores the impact of different dissemination channels on the awareness and usage of a hospital performance reporting initiative, namely the Nuremberg hospital quality reporting system (NHQRS), among referring physicians, as well as the usefulness of such reports from the referring physicians’ perspective. The latter publicly reported about the quality of care of hospitals for 14 clinical procedures in the region of Nuremberg (Bavaria, Germany) between January and April 2016
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