Public Release Of Performance Data Research Articles

Can competition improve hospital quality of care? A difference-in-differences approach to evaluate the effect of increasing quality transparency on hospital quality

Public reporting on the quality of care is intended to guide patients to the provider with the highest quality and to stimulate a fair competition on quality. We apply a difference-in-differences design to test whether hospital quality has improved more in markets that are more competitive after the first public release of performance data in Germany in 2008. Panel data from 947 hospitals from 2006 to 2010 are used. Due to the high complexity of the treatment of stroke patients, we approximate general hospital quality by the 30-day risk-adjusted mortality rate for stroke treatment. Market structure is measured (comparatively) by the Herfindahl–Hirschman index (HHI) and by the number of hospitals in the relevant market. Predicted market shares based on exogenous variables only are used to compute the HHI to allow a causal interpretation of the reform effect. A homogenous positive effect of competition on quality of care is found. This effect is mainly driven by the response of non-profit hospitals that have a narrow range of services and private for-profit hospitals with a medium range of services. The results highlight the relevance of outcome transparency to enhance hospital quality competition.

Impact of public release of performance data on the behaviour of healthcare consumers and providers.

It is becoming increasingly common to publish information about the quality and performance of healthcare organisations and individual professionals. However, we do not know how this information is used, or the extent to which such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers, and purchasers. To estimate the effects of public release of performance data, from any source, on changing the healthcare utilisation behaviour of healthcare consumers, providers (professionals and organisations), and purchasers of care. In addition, we sought to estimate the effects on healthcare provider performance, patient outcomes, and staff morale. We searched CENTRAL, MEDLINE, Embase, and two trials registers on 26 June 2017. We checked reference lists of all included studies to identify additional studies. We searched for randomised or non-randomised trials, interrupted time series, and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or professionals. Each study had to report at least one main outcome related to selecting or changing care. Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers, and healthcare purchasers), performance data, main outcomes (choice of healthcare provider, and improvement by means of changes in care), and other outcomes (awareness, attitude, knowledge of performance data, and costs). Given the substantial degree of clinical and methodological heterogeneity between the studies, we presented the findings for each policy in a structured format, but did not undertake a meta-analysis. We included 12 studies that analysed data from more than 7570 providers (e.g. professionals and organisations), and a further 3,333,386 clinical encounters (e.g. patient referrals, prescriptions). We included four cluster-randomised trials, one cluster-non-randomised trial, six interrupted time series studies, and one controlled before-after study. Eight studies were undertaken in the USA, and one each in Canada, Korea, China, and The Netherlands. Four studies examined the effect of public release of performance data on consumer healthcare choices, and four on improving quality.There was low-certainty evidence that public release of performance data may make little or no difference to long-term healthcare utilisation by healthcare consumers (3 studies; 18,294 insurance plan beneficiaries), or providers (4 studies; 3,000,000 births, and 67 healthcare providers), or to provider performance (1 study; 82 providers). However, there was also low-certainty evidence to suggest that public release of performance data may slightly improve some patient outcomes (5 studies, 315,092 hospitalisations, and 7502 providers). There was low-certainty evidence from a single study to suggest that public release of performance data may have differential effects on disadvantaged populations. There was no evidence about effects on healthcare utilisation decisions by purchasers, or adverse effects. The existing evidence base is inadequate to directly inform policy and practice. Further studies should consider whether public release of performance data can improve patient outcomes, as well as healthcare processes.

Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations

It is becoming increasingly common to release information about the performance of hospitals, health professionals or providers, and healthcare organisations into the public domain. However, we do not know how this information is used and to what extent such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers and purchasers, or to what extent the performance of professionals and providers can be affected. To determine the effectiveness of the public release of performance data in changing the behaviour of healthcare consumers, professionals and organisations. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, MEDLINE Ovid (from 1966), EMBASE Ovid (from 1979), CINAHL, PsycINFO Ovid (from 1806) and DARE up to 2011. We searched for randomised or quasi-randomised trials, interrupted time series and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or individuals. The papers had to report at least one main outcome related to selecting or changing care. Other outcome measures were awareness, attitude, views and knowledge of performance data and costs. Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers and healthcare purchasers), performance data, main outcomes (choice of healthcare provider and improvement by means of changes in care) and other outcomes (awareness, attitude, views, knowledge of performance data and costs). We included four studies containing more than 35,000 consumers, and 1560 hospitals. Three studies were conducted in the USA and examined consumer behaviour after the public release of performance data. Two studies found no effect of Consumer Assessment of Healthcare Providers and Systems information on health plan choice in a Medicaid population. One interrupted time series study found a small positive effect of the publishing of data on patient volumes for coronary bypass surgery and low-complication outliers for lumbar discectomy, but these effects did not persist longer than two months after each public release. No effects on patient volumes for acute myocardial infarction were found.One cluster-randomised controlled trial, conducted in Canada, studied improvement changes in care after the public release of performance data for patients with acute myocardial infarction and congestive heart failure. No effects for the composite process-of-care indicators for either condition were found, but there were some improvements in the individual process-of-care indicators. There was an effect on the mortality rates for acute myocardial infarction. More quality improvement activities were initiated in response to the publicly-released report cards. No secondary outcomes were reported. The small body of evidence available provides no consistent evidence that the public release of performance data changes consumer behaviour or improves care. Evidence that the public release of performance data may have an impact on the behaviour of healthcare professionals or organisations is lacking.

Information management of medical errors in Greece: The MERIS proposal

There is a substantial amount of public concern about patient safety, as, according to estimates from major studies, hundreds of thousands die in hospitals each year all over the developed world as a result of medical errors that could have been prevented. Unprecedented research commissioned by the EU has found that almost one out of every four families has experienced a serious medical error. Greek citizens concerning about serious medical errors in the hospital environment, were at the top of the list. Greek Ombudsman's report on medical errors has raised the debate among health policy makers as to the appropriate response to the problem. Proposals range from the implementation of nationwide mandatory reporting with public release of performance data, to voluntary reporting and quality-assurance efforts that protect the confidentiality of error-related data. Any successful safety program will first require a national effort to make significant investments in information systems, along with providing an environment and education that enables to contribute to an active quality improvement process. In this paper we propose the development and implementation of Medical Error Reporting Information System ( MERIS), in order to identify, collect, analyse and report medical errors and patient adverse events, as a tool for enhancing patient safety and health care quality. We also describe the necessary organisational structure and the infrastructure environment of the system and the barriers to its successful implementation.

Systematic Review: The Evidence That Publishing Patient Care Performance Data Improves Quality of Care

Previous reviews have shown inconsistent effects of publicly reported performance data on quality of care, but many new studies have become available in the 7 years since the last systematic review. To synthesize the evidence for using publicly reported performance data to improve quality. Web of Science, MEDLINE, EconLit, and Wilson Business Periodicals (1999-2006) and independent review of articles (1986-1999) identified in a previous systematic review. Only sources published in English were included. Peer-reviewed articles assessing the effects of public release of performance data on selection of providers, quality improvement activity, clinical outcomes (effectiveness, patient safety, and patient-centeredness), and unintended consequences. Data on study participants, reporting system or level, study design, selection of providers, quality improvement activity, outcomes, and unintended consequences were extracted. Forty-five articles published since 1986 (27 of which were published since 1999) evaluated the impact of public reporting on quality. Many focus on a select few reporting systems. Synthesis of data from 8 health plan-level studies suggests modest association between public reporting and plan selection. Synthesis of 11 studies, all hospital-level, suggests stimulation of quality improvement activity. Review of 9 hospital-level and 7 individual provider-level studies shows inconsistent association between public reporting and selection of hospitals and individual providers. Synthesis of 11 studies, primarily hospital-level, indicates inconsistent association between public reporting and improved effectiveness. Evidence on the impact of public reporting on patient safety and patient-centeredness is scant. Heterogeneity made comparisons across studies challenging. Only peer-reviewed, English-language articles were included. Evidence is scant, particularly about individual providers and practices. Rigorous evaluation of many major public reporting systems is lacking. Evidence suggests that publicly releasing performance data stimulates quality improvement activity at the hospital level. The effect of public reporting on effectiveness, safety, and patient-centeredness remains uncertain.

PICC the Music and Travel to the Port of Relaxation: Preliminary Results of the Effects of Music on Perceived Pain and Anxiety During the Placement of Ports and PICCs

There is a substantial amount of public concern about patient safety, as, according to estimates from major studies, hundreds of thousands die in hospitals each year all over the developed world as a result of medical errors that could have been prevented. Unprecedented research commissioned by the EU has found that almost one out of every four families has experienced a serious medical error. Greek citizens concerning about serious medical errors in the hospital environment, were at the top of the list. Greek Ombudsman's report on medical errors has raised the debate among health policy makers as to the appropriate response to the problem. Proposals range from the implementation of nationwide mandatory reporting with public release of performance data, to voluntary reporting and quality-assurance efforts that protect the confidentiality of error-related data. Any successful safety program will first require a national effort to make significant investments in information systems, along with providing an environment and education that enables to contribute to an active quality improvement process. In this paper we propose the development and implementation of Medical Error Reporting Information System (MERIS), in order to identify, collect, analyse and report medical errors and patient adverse events, as a tool for enhancing patient safety and health care quality. We also describe the necessary organisational structure and the infrastructure environment of the system and the barriers to its successful implementation.

About Context and Systems

This commentary on the paper of Adalsteinn Brown et al. addresses the various tensions between global evidence, general theories and local change processes. Following up on this analysis, the paper also discusses the impact of public performance data on both consumer behaviour and provider behaviour. The four lessons presented by Brown et al. are put in the context of considering the public release of performance data as a social process and an integral part of the Canadian health system design and functioning.

Measures of surgical quality: what will patients know by 2005?

Many objective measures rating quality of doctors, hospitals, and medical groups are publicly reported. Surgical patients may have more opportunity to use quality measures than other types of patients to guide their choice of provider. If surgical patients are able to choose higher quality providers, overall surgical quality might increase. To determine what procedure-specific measures of surgical quality are available to consumers facing surgery in California and what new measures will be available by 2005. We searched for and surveyed organizations publicly reporting data on health care quality in California. We asked about current quality measures and new measures set for public release by 2005. Included measures had to be procedure-specific and results separated by hospital. The main outcome measures were the number of quality measures; conceptual aspect of quality measured; and type of risk-adjustment used. Eighteen organizations publicly report any health care quality measures in California. These organizations report 333 measures, of which 32 (10%) are procedure-specific measures of surgical quality. There is at least one quality measure for 21 different procedures; these procedures account for 14% of all major operations. Three new measures will be released by 2005. Californians facing surgery have limited information regarding quality of their care; few new measures are planned. Eighty-six per cent of patients would find no quality measures related to planned procedures. Public release of performance data is unlikely to improve the quality of health care unless the number and comprehensiveness of measures increase dramatically.

Analytic Reviews: Considerations in the Development of Intensive Care Unit Report Cards

Concerns over health care quality have prompted calls for the public release of performance data, or “report cards,” as one strategy for improving quality. Any initiative to create a report card should start with the selection of valid quality indicators. This is complicated by the need to account for variations in case mix among intensive care units (ICUs), the difficulty in defining which patients are receiving critical care, and the fact that pre-ICU and post-ICU care can influence the outcomes of care for ICU patients. The difficulties in measuring quality accurately make some providers reluctant to release performance data to the public, but advocates of public disclosure point to examples of improved quality after publication of report cards. Consumer and purchaser demand for report cards continues to increase, so public reporting of performance data likely will become more common. In light of this trend, it is important for physicians to become involved in the development of report cards to ensure that quality measurement is valid and that the data are used for quality improvement.

The Public Release of Performance Data: What Do We Expect to Gain? A Review of the Evidence

The Public Release of Performance Data: What Do We Expect to Gain? A Review of the Evidence

Medical errors: how the US Government is addressing the problem

November's Institute of Medicine (IOM) report on medical errors has sparked debate among US health policy makers as to the appropriate response to the problem. Proposals range from the implementation of nationwide mandatory reporting with public release of performance data to voluntary reporting and quality-assurance efforts that protect the confidentiality of error-related data. Any successful safety program will require a national effort to make significant investments in information technology infrastructure, and to provide an environment and education that enables providers to contribute to an active quality-improvement process.

The public release of performance data: what do we expect to gain? A review of the evidence.

Information about the performance of hospitals, health professionals, and health care organizations has been made public in the United States for more than a decade. The expected gains of public disclosure have not been made clear, and both the benefits and potential risks have received minimal empirical investigation. To summarize the empirical evidence concerning public disclosure of performance data, relate the results to the potential gains, and identify areas requiring further research. A literature search was conducted on MEDLINE and EMBASE databases for articles published between January 1986 and October 1999 in peer-reviewed journals. Review of citations, public documents, and expert advice was conducted to identify studies not found in the electronic databases. Descriptive, observational, or experimental evaluations of US reporting systems were selected for inclusion. Included studies were organized based on use of public data by consumers, purchasers, physicians, and hospitals; impact on quality of care outcomes; and costs. Seven US reporting systems have been the subject of published empirical evaluations. Descriptive and observational methods predominate. Consumers and purchasers rarely search out the information and do not understand or trust it; it has a small, although increasing, impact on their decision making. Physicians are skeptical about such data and only a small proportion makes use of it. Hospitals appear to be most responsive to the data. In a limited number of studies, the publication of performance data has been associated with an improvement in health outcomes. There are several potential gains from the public disclosure of performance data, but use of the information by provider organizations for quality improvement may be the most productive area for further research.

Lessons from Europe on Quality Improvement: Report on the Velen Castle WHO Meeting

In conjunction with the German Ministry of Health, the European Regional Office of the World Health Organization (WHO/EURO) held a workshop, "Experiences with Quality Management in an International Context," at Velen Castle, Velen (Nordrhein-Westfalen), Germany, January 15-17, 1998. The approximately 50 participants were selected in part on the basis of recommendations of their respective countries' health ministries. Possible ways to introduce quality management ranged from introduction of specific process control projects to total quality management (TQM) and reengineering. Working group sessions identified specific strategies for high-level managers, health care providers, and various kinds of consumers to facilitate quality management. For example, managers need to transmit a vision, create a quality management infrastructure, develop reporting structures, establish a system of incentives, and manage the hospital according to the principles of continuous improvement. Hospitals and other health care providers in Sweden are testing various methods and systems to assess and improve their organizations' ability to meet patients' demands. Benchmarking is being used as a tool for quality management of diabetes care (DiabCare-France). The benchmarking data are processed centrally and made available to the health care providers in a user-friendly format for application to their own quality improvement processes. Clinical databases-registries containing process and outcome data for a well-defined patient population-can be used for quality and technology assessment, to answer questions of treatment effectiveness, and as an information tool. Successful implementation of quality improvement benefits from local, professional, and national policies and objectives. A balance of incentives can reward efficiency or specific activities. Laws, rules, and regulations can be useful, especially if used sparingly. More education is needed at all levels of the health care system about how to understand and use information and information systems. Research is needed on what processes result in favorable outcomes. Despite optimism about the cost-saving potential of quality improvement efforts, many interventions are likely to be cost-effective without actually saving costs. Public release of performance data requires careful consideration, with participation of the professions.

Measuring what matters to the public.

Perspective Health AffairsVol. 17, No. 4 Perspective: Measuring What Matters To The PublicDavid Lansky Affiliations David Lansky is president of the Foundation for Accountability (FACCT) in Portland, Oregon. Health Affairs invited his comments on the paper by David Eddy, which precedes this Perspective. PUBLISHED:July/August 1998No Accesshttps://doi.org/10.1377/hlthaff.17.4.40AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View article"Perspective: Measuring What Matters To The Public." Health Affairs, 17(4), pp. 40–41TOPICSHealth care providersSystems of careHealth outcomesHospital medical staffHospital performanceAccess to care Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 31 History Published online 1 July 1998 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.PDF downloadCited ByCommunication with a neurological patientZhurnal nevrologii i psikhiatrii im. S.S. Korsakova, Vol. 122, No. 2Overview of Older People, Ageing and Diabetes, the Disease5 March 2018Effect of computer use on physician-patient communication using a validated instrument: Patient perspectiveInternational Journal of Medical Informatics, Vol. 108Educational interventions for improving the communication skills of general practice trainees in the clinical consultation10 May 2017 | Cochrane Database of Systematic Reviews, Vol. 21Postscript22 May 2014 | Medical Care Research and Review, Vol. 71, No. 5_supplHealthcare Performance Reports29 September 2014The quality frontierFuture Oncology, Vol. 10, No. 4Does Hospital Reputation Influence the Choice of Hospital?SSRN Electronic Journal“Best Practice” for Patient-Centered Communication: A Narrative ReviewJournal of Graduate Medical Education, Vol. 5, No. 3Prediction of Hospital Acute Myocardial Infarction and Heart Failure 30-Day Mortality Rates Using Publicly Reported Performance MeasuresJournal for Healthcare Quality, Vol. 35, No. 2Patient Education in NeurologyNeurologic Clinics, Vol. 28, No. 2Assessing and Managing All Aspects of Migraine: Migraine Attacks, Migraine-Related Functional Impairment, Common Comorbidities, and Quality of LifeMayo Clinic Proceedings, Vol. 84, No. 5Facilitating communication with patients for improved migraine outcomes10 October 2008 | Current Pain and Headache Reports, Vol. 12, No. 3The assessment of doctors' performance: Tools and techniques18 July 2013 | Journal of Management & Marketing in Healthcare, Vol. 1, No. 4Achieving Quality Health Services for Adolescents1 June 2008 | Pediatrics, Vol. 121, No. 6Do new health conditions support mortality–air pollution effects?Journal of Environmental Economics and Management, Vol. 50, No. 3Educational interventions for improving the communication skills of general practice trainees in the clinical consultation19 October 2005Quality Care for People with HIV/AIDS: Patients’ Perspectives23 February 2015 | HIV Clinical Trials, Vol. 5, No. 6Assessing Competence in Communication and Interpersonal Skills: The Kalamazoo II ReportAcademic Medicine, Vol. 79, No. 6The effectiveness of the public release of performance data in changing consumer, healthcare professional or organisational behaviour.20 October 2003Difusión de resultados asistenciales: ventajas e inconvenientes de los report cardsRevista de Calidad Asistencial, Vol. 18, No. 4A Research Agenda to Advance Quality Measurement and ImprovementMedical Care, Vol. 41, No. SupplementReporting health care performance: learning from the past, prospects for the future13 June 2002 | Journal of Evaluation in Clinical Practice, Vol. 8, No. 2Relative Impact of Patient and Clinic Factors on Adherence to Primary Care Preventive Service GuidelinesMedical Care, Vol. 39, No. 9Improving Adolescent Preventive Care in Community Health Centers1 February 2001 | Pediatrics, Vol. 107, No. 2American Journal of Respiratory and Critical Care Medicine, Vol. 164, No. 3Performance Measurement Through Audit, Feedback, and Profiling as Tools for Improving Clinical CareChest, Vol. 118, No. 2Internet-Based Monitoring and Benchmarking in Ambulatory Surgery CentersThe Joint Commission Journal on Quality Improvement, Vol. 26, No. 8CONQUEST 2.0: An Emerging Clinical Performance Measurement ToolJournal For Healthcare Quality, Vol. 22, No. 3Consumers' Descriptions of Quality Health CareJournal of Nursing Care Quality, Vol. 14, No. 1More Evidence For The Insurability Of Managed Behavioral Health CareCosts need notrise when more generous benefits are offered.William Goldman, Joyce McCulloch, Brian Cuffel, and Danah Kozma13 December 2018 | Health Affairs, Vol. 18, No. 5