Health Care Report Cards Research Articles

Public Reporting and Consumer Demand in the Home Health Sector.

Health care report cards improve information and are a crucial part of health care reform of the federal government of the United States. I exploit a natural experiment in the home health sector to assess whether a higher rating under the star ratings program affects patient choice. Higher rated agencies increased their market share by 1.4% or 0.25 (95% confidence interval: [-0.63, 1.12]) percentage points, a practically and statistically insignificant amount. I find no evidence of heterogeneous effects across the rating distribution or over time. I also find precise null effects among consumers expected to be more responsive, including community-entry patients and patients in competitive markets with more options and star types. Agencies may have modestly impeded consumer choice by engaging in some patient selection behaviors, although the evidence is only weakly suggestive. The star ratings are unlikely to improve home health quality despite continued policymaker interest.

Patient selection in the presence of regulatory oversight based on healthcare report cards of providers: the case of organ transplantation.

Many healthcare report cards provide information to consumers but do not represent a constraint on the behavior of healthcare providers. This is not the case with the report cards utilized in kidney transplantation. These report cards became more salient and binding, with additional oversight, in 2007 under the Centers for Medicare and Medicaid Services Conditions of Participation. This research investigates whether the additional oversight based on report card outcomes influences patient selection via waiting-list registrations at transplant centers that meet regulatory standards. Using data from a national registry of kidney transplant candidates from 2003 through 2010, we apply a before-and-after estimation strategy that isolates the impact of a binding report card. A sorting equilibrium model is employed to account for center-level heterogeneity and the presence of congestion/agglomeration effects and the results are compared to a conditional logit specification. Our results indicate that patient waiting-list registrations change in response to the quality information similarly on average if there is additional regulation or not. We also find evidence of congestion effects when spatial choice sets are smaller: new patient registrations are less likely to occur at a center with a long waiting list when fewer options are available.

Consumer Response to Composite Ratings of Nursing Home Quality.

Health care report cards are intended to address information asymmetries and enable consumers to choose providers of better quality. However, the form of the information may matter to consumers. Nursing Home Compare, a website that publishes report cards for nursing homes, went from publishing a large set of indicators to a composite rating in which nursing homes are assigned one to five stars. We evaluate whether the simplified ratings motivated consumers to choose better-rated nursing homes. We use a regression discontinuity design to estimate changes in new admissions six months after the publication of the ratings. Our main results show that nursing homes that obtained an additional star gained more admissions, with heterogeneous effects depending on baseline number of stars. We conclude that the form of quality reporting matters to consumers, and that the increased use of composite ratings is likely to increase consumer response.

Developing citizen report cards for primary health care in low and middle-income countries: Results from cognitive interviews in rural Tajikistan.

Citizen report cards on health care providers have been identified as a potential means to increase citizen engagement, provider accountability and health systems performance. Research in high-income settings indicates that the wording, presentation and display of performance information are critical to achieve these goals. However, there are limited insights on developing effective report card designs for middle- and low-income settings. We conducted cognitive interviews to assess consumers’ understanding, interpretation of and preferences for displaying information for a health care report card in rural Tajikistan. We recruited a convenience sample of 40 citizens (20 women and 20 men aged 18–45) from rural areas of two provinces of Tajikistan (Soghd and Khatlon oblasts). The interview protocol was adapted from the model of cognitive interviews used in social science research to improve survey questionnaires. We used multivariate regression to assess understanding and interpretation of the report card; chi2 tests to assess differences in preferences for displaying information; and tests of proportions to assess the preferred comparison group. Respondents understood the main idea of the report card and are not confused by the indicators or display. However, many respondents had difficulties making comparisons, and when asked to identify worst-performing services. Respondents preferred detailed rankings using school grades, comparisons of their local clinic with the regional or national average performance, and the use of color in the report card. We found some heterogeneity across the two provinces. Overall, our findings are promising regarding the citizens’ comprehension of health care report cards in rural Tajikistan, while underscoring the challenges of effectively providing health care performance information to communities. Cognitive interviews and iterative testing can support an effective implementation of reporting initiatives.

Body Mass Index in the Early Years in Relation to Motor Coordination at the Age of 5⁻7 Years.

Physical activity (PA) and body mass index (BMI) are consistently associated with motor coordination (MC) in children. However, we know very little how BMI in early childhood associates with MC later in childhood. This study investigated associations between BMI in early childhood and BMI, PA, and MC in middle childhood. Children aged 5 to 7 years (n = 64, 32 girls) were measured for MC using Körperkoordinationstest für Kinder (KTK) and for moderate-to-vigorous PA (MVPA) using triaxial accelerometers. Prevailing body weight and height were measured, and information on weight and height in early years was based on parental report of child health care report cards. Age-adjusted BMIz scores were calculated on the basis of international growth curve references. Associations and the explained variability of MC were investigated by Pearson correlations and a hierarchical multiple regression analysis. Age and MVPA were found to be significantly associated with MC at middle childhood, in general. BMIz at middle childhood and at ages 4 and 5 years inversely explained 12% (p < 0.05), 6% (p > 0.05), and 7% (p > 0.05) of the variation in MC in girls after adjusting for covariates, respectively. In boys, BMIz scores did not show any trend of association with MC. This study suggests sex-specific mechanisms in the interplay between BMI and motor development in childhood.

The Role of Severe Dementia in Nursing Home Report Cards.

Health care report cards are intended to improve quality, but there may be considerable heterogeneity in who benefits. In this article, we examine the intended and unintended effects of quality reporting for nursing home residents with severe dementia relative to other residents, using a difference-in-differences design to examine selected reported and unreported quality measures. Our results indicate that prior to public reporting, nursing home residents with severe dementia were at significantly higher risk of poor outcomes on most reported quality measures. After public reporting was initiated, outcomes for nursing home residents with severe dementia did not consistently improve or worsen. We see no evidence that individuals with severe dementia are being avoided by nursing homes, despite their potential negative impact on quality scores, but we do find an increase in coding of end-stage disease. Additional risk-adjustment, stratification, or additional quality measures may be warranted.

Health Care Report Cards and Baseball Statistics: Is There a Linkage?

Health Care Report Cards and Baseball Statistics: Is There a Linkage?

Health Care Report Cards: Why Should Community Pharmacists Care?

Health Care Report Cards: Why Should Community Pharmacists Care?

Information Resources: Health Care Report Cards: Pass or Fail?

Information Resources: Health Care Report Cards: Pass or Fail?

An ethical framework for cardiac report cards: a qualitative study

BackgroundThe recent proliferation of health care report cards, especially in cardiac care, has occurred in the absence of an ethical framework to guide in their development and implementation. An ethical framework is a consistent and comprehensive theoretical foundation in ethics, and is formed by integrating ethical theories, relevant literature, and other critical information (such as the views of stakeholders). An ethical framework in the context of cardiac care provides guidance for developing cardiac report cards (CRCs) that are relevant and legitimate to all stakeholders. The purpose of this study is to develop an ethical framework for CRCs.MethodsDelphi technique – 13 panelists: 2 administrators, 2 cardiac nurses, 5 cardiac patients, 2 cardiologists, 1 member of the media, and 1 outcomes researcher. Panelists' views regarding the ethics of CRCs were analyzed and organized into themes.ResultsWe have organized panelists' views into ten principles that emerged from the data: 1) improving quality of care, 2) informed understanding, 3) public accountability, 4) transparency, 5) equity, 6) access to information 7) quality of information, 8) multi-stakeholder collaboration, 9) legitimacy, and 10) evaluation and continuous quality improvement.ConclusionWe have developed a framework to guide the development and dissemination of CRCs. This ethical framework can provide necessary guidance for those generating CRCs and may help them avoid a number of difficult issues associated with existing ones.

The reliability and validity of Bayesian measures for hospital profiling: a Monte Carlo assessment

There is a growing trend towards the production of “hospital report-cards” in which hospitals with higher than acceptable mortality rates are identified. Several commentators have advocated for the use of Bayesian methods for health care report cards. Earlier research has demonstrated that there is poor concordance between different Bayesian methods. The current study used Monte Carlo simulation methods to examine the reliability and validity of four different Bayesian measures of hospital performance. Estimates of the reliability of the different measures ranged from a low of 0.89 to a high of 0.99. Estimates of the validity of the four measures ranged from a low of 0.58 to a high of 0.65. Thus, while the four measures of hospital performance demonstrated high reliability, the validity of each method was at most moderate. It is hypothesized that the low validity is due in part to the limited sample sizes that are typically available for hospital report cards.

Claiming the future of nursing through nursing-sensitive quality indicators.

Although many of the changes in today's health care arena have been beneficial, there continues to be persistent dissatisfaction with the nation's health care delivery system. The provision of outcome-oriented, cost-effective health care is no longer a goal. It is a mandate. To accomplish this mandate, the relationship between the costs, quality and desired outcomes of care, and the processes involved in providing care must be reexamined. This article describes factors stimulating the American Nurses Association to develop nursing-sensitive quality indicators, details development of the National Database for Nursing Quality Indicators (NDNQI), and discusses the implications of nursing-sensitive indicators and NDNQI for nurse administrators. Nursing's quality indicators can be of value in the development of evidence-based health care report cards and can be used to direct change. We must move forward together in claiming the future of nursing through nursing-sensitive quality indicators.

Impact of an acute myocardial infarction report card in Ontario, Canada.

Acute myocardial infarction (AMI) 'report cards' are being developed using administrative databases in many jurisdictions, but little is known about their acceptance by and their usefulness to the medical community. The purpose of this study was to determine the impact of the publication of Cardiovascular Health and Services in Ontario: An ICES Atlas (Naylor CD, Slaughter P. (eds), 1999, Toronto: ICES), the first report featuring hospital-specific AMI performance measures to be published in Canada. We conducted a mail survey of physicians at Ontario hospitals to determine their views on the usefulness of various atlas performance measures for assessing and improving quality of care, the types of quality initiatives launched at their hospital in response to the atlas, and their views on the concept and limitations of reporting hospital-specific AMI mortality data. Respondents to the survey indicated that information on process of care measures such as post-infarction beta-blocker and angiotensin-converting enzyme (ACE) inhibitor use, and cardiac procedure waiting times were the most useful, and outcomes data (e.g. 30-day and 1-year risk-adjusted AMI mortality rates) the least useful of the multiple performance measures published in the atlas (P = 0.0385). Fifty-four percent of respondents reported launching one or more quality of care initiatives at their hospital in response to the atlas. The majority of respondents (65%) indicated that they support the public release of hospital-specific AMI mortality data, although many had concerns about potential miscoding in administrative databases and the adequacy of risk-adjustment methods. The publication of the first AMI report card in Canada stimulated quality of care initiatives at many Ontario hospitals. Inclusion of performance measures other than mortality in health care report cards may lead to greater acceptance and use by the medical community.

Report cards: relevance for nursing and patient care safety

The emergence of health care report cards in the North American environment is outlined. While it is evident that substantial activity has emerged, the majority of these initiatives excluded nursing, or use a broad indicator for nursing that may not provide meaningful representations of the quality of nursing care provided in the system and the relevance of this care to patient care safety. Given that nurses are the primary care provider in health care settings, this represents a significant gap in health care report cards. The pioneering work of the American Nurses Association (ANA) Nursing Report Card in the development and validation of report card indicators for nursing is discussed. Challenges related to data availability and data quality are identified. Potential opportunities for linking nursing practice outcomes to patient care quality and patient safety through a report card process are outlined.

Consumers' descriptions of quality health care.

Consumer-oriented health care report cards have emerged as a strategy to disseminate information to consumers about the quality of health plans and relative costs, with the goal of enabling them to make informed choices. While consumers have reported an interest in having access to this information, how they actually define quality of care is not yet clear. Despite extensive research on defining and measuring health care quality, less attention has been given to consumers' perspectives of quality care. In this study, 239 consumers were interviewed using four open-ended questions on their descriptions of quality health care and quality nursing care. Consumers described quality health care in terms of access to care (n = 143), followed by having competent and skilled providers (n = 104) and receiving the proper treatment (n = 100). Consumers defined quality nursing care as having nurses who were concerned about them and demonstrated caring behaviors (n = 148), were competent and skilled (n = 115), communicated effectively with them (n = 99), and taught them about their care (n = 97).

Assessing Health Care Report Cards

Report cards have become a prominent feature of the health policy landscape (F. Thompson 1994; Epstein 1995; Corrigan and Rogers 1995; Brennan and Berwick 1996). Although the federal government no longer distributes annual hospital report cards, many state governments do. Some state governments also have begun to distribute report cards on health maintenance organizations (HMOs). In addition, one state government releases periodic reports on nursing homes, based on state inspections.

Health care report cards

AORN JournalVolume 67, Issue 3 p. 669-672 Department Health care report cards Dorothy M. Fogg RN, MA, Dorothy M. Fogg RN, MA Perioperative nursing specialist Center for Nursing Practice, Health Policy, and ResearchSearch for more papers by this author Dorothy M. Fogg RN, MA, Dorothy M. Fogg RN, MA Perioperative nursing specialist Center for Nursing Practice, Health Policy, and ResearchSearch for more papers by this author First published: 01 March 1998 https://doi.org/10.1016/S0001-2092(06)62837-8Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume67, Issue3March 1998Pages 669-672 RelatedInformation

Health-care report cards and implications for anesthesia.

Health-care report cards and implications for anesthesia.

The MHSIP mental health report card. A consumer-oriented approach to monitoring the quality of mental health plans. Mental Health Statistics Improvement Program.

Health care report cards have been endorsed as a mechanism for efficiently comparing key quantifiable aspects of performance across a range of health systems or plans. There are challenges in determining what to measure; how to gather and analyze data; and how to report, interpret, and use findings. Mental health has received little attention, and a consumer perspective is typically not included. The proposed MHSIP mental health report card (MMHRC) addresses these concerns. General issues for report cards are discussed, and the MMHRC is described in terms of content, data sources and quality, and analysis and reporting.

What type of quality information do consumers want in a health care report card?

Health care report cards have emerged as a new tool to achieve better informed consumer choice and improved health plan performance. With this new emphasis on information dissemination, almost all the attention and effort has gone into the development of valid measures of quality and plan performance. Very little attention is given to the question of what consumers want for making choices or how they will use the measures for choosing health plans. This study uses afocus group methodology and content analysis to explore consumer concepts of quality and to determine how consumers view the quality-of-care indicators that are appearing in report cards. The findings show that consumers have a high interest in quality information. There is a stated preference for quality indicators that reveal how well the plans perform on preventive care and on consumer satisfaction. Asking participants to actually make a plan choice on the basis of comparative plan performance data showed that stated preferences for types of information were inconsistent with actual choices.