5. Public Reporting as a Quality Improvement Strategy

the staff; they viewed performance information as a supplement to information from
other sources; they wanted narrative descriptions as well as numbers; they disliked league
tables; and they were not confident about the source of quality information (2006).
• Barr and colleagues interviewed 56 physicians and during the interviews they presented
scenarios that varied in terms of patient age and diagnosis in which patients asked
questions about a referral based on information from a public report. They categorized
physician responses into four major themes: (a) rely on existing physician-patient
relationships; (b) acknowledge and consider patient perspectives; (c) take actions to
follow up on patient concerns; and (d) provide their perspectives on quality reports, and
also reported that physicians were concerned about the methodological rigor of reports
(2008). 174
• In Massachusetts, researchers interviewed 72 leaders of physician group practices that
provided primary care about their awareness and use of a new physician group report on
patient experience. Seventeen percent were not aware of the report and 22 percent used
the report to focus on low performers, while 61 percent reported instigating group-wide
improvement activities based on the results. The most common QI activities concerned
access (57 percent), communication with patients (48 percent), and customer service
(45 percent) (2010). 175
Two lab-type experiments and one focus group study were used to determine patient
preferences for different types of information and different formats.
• In an experiment that offered participants (n=301 adult volunteers) choices between
two physicians and provided rating of technical and interpersonal quality, 66 percent
of people selected the physician with higher technical quality three or more out of
five possible times, leading the authors to conclude that technical quality is more
important to potential patients (2005). 177
• Stein et al. conducted four focus groups in Pennsylvania with mental health care
consumers who were Medicaid beneficiaries. Participants said they wanted
information about providers, but specific items they valued such as flexibility in
scheduling, ability to talk to the doctor, and shared decisionmaking were not the items
available from public reports (2009). 176
• Donelan and colleagues 178 recruited 337 adults to review four different versions of
records on CABG outcomes for fictional, individual surgeons. The versions varied in
both format (text, charts, and graphical indicators) and the data presented. Participants
were asked to select the surgeon with the lowest mortality rate and to rate different
versions in terms of their usefulness. Participants viewed the type of data as important
with 40 percent saying it was “absolutely essential” and 42 percent “very important.”
The ability to correctly select the surgeon varied from 66 percent based on a version
that included graphical indicators to 16 percent when using a text-table. However, the
text-table that resulted in the lowest percentage of correct identifications of the lowest
mortality surgeon was the one most frequently cited as the most useful (selected by
37 percent of participants) (2011).
Additional information extracted from these qualitative studies is included in the Evidence
Tables in Appendix K.
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