5. Public Reporting as a Quality Improvement Strategy

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Table 4. Summary of evidence: Quality of individual clinicians and outpatient clinics (continued) Author Year Key Results (QA) Public Report Study Overview Question (↑Improvement; ↓Worse; ↔No Difference) Ranganathan 2009 110 Bridges to Evaluates the effect of the 5 Website received 789 hits (11.9% hit rate) Excellence mode (internet vs. mail) and ↑Odds of registration was 6.42 times higher in email vs mail for active (Fair) (created by a the tone of the invitation to employees p
Health Plans Rating and reporting of health plans is linked to the growth of managed care in both the private health insurance market and public health insurance programs. Also important have been the active roles employers and employer purchaser coalitions began to play as agents for their employees in the late 1980s and early 1990s. Businesses went from simple provision of health insurance to active involvement in creating and offering more options and models of health insurance; advancing a quality improvement agenda in health care; and selecting, or in some cases creating, the health plans available to employees. These changes were motivated both by the desire to control the rising costs of health care coverage and to assure a healthy and more productive workforce. At the same time public programs such as Medicaid and Medicare began offering and sometimes requiring enrollment in managed care plans. Health plans are selected when people start a job or become eligible for a public insurance program. First health plans must be included among the options offered by employers and public programs. Then health plans must appeal to employees and beneficiaries who select from among the offered options. People select health plans for ongoing and future health care needs, and can change plans once yearly during open enrollment periods or if their status changes (e.g., spouse loses coverage from another employer, newborn is added). Health plans may try to increase their market share by offering different combinations of quality of information, benefits, premium structures, and more or less restricted access to providers (physicians, specialists, hospitals, prescription drugs, etc.). We identified 24 quantitative studies and 32 (reported in 35 articles) qualitative studies labtype experiments about public reporting of quality information related to health plans that met our inclusion criteria and fit our analytic model. Information abstracted from the articles is included in the Evidence Tables in Appendix L and Appendix M. Overview of Findings Quality of Care (Key Question 1) • Quality measures improved for almost all HEDIS and CAHPS domains studied after public reporting (five studies). 53-57 • During the time period in which some plans allowed their HEDIS measures to be publicly reported while others submitted data but did not allow it to be released, plans that voluntarily released quality data had higher-quality scores 54,55 (two studies) even after controlling for differences in plans (one study). 55 Harms (Key Question 2) • Potential harms were examined in two of the included studies. The potential harms were crowding out which refers to declining quality of care in areas not measured due to a focus on the aspects of care that are measured 70 and withdrawal of high-quality plans from the market. 71 Neither study found evidence of these harms. Impact on Providers (Key Question 3) • No studies were identified. 82
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Evidence Report/Technology Assessme
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This report is based on research co
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Acknowledgments We would like to ac
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Public Reporting as a Quality Impro
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Tables Table A. Summary Evidence Ta
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and using reports and other decisio
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• Outcomes (specified for each Ke
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Methods A Technical Expert Panel fo
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setting), and the strength of the b
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Table A. Summary evidence table: ef
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was at the time the included studie
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6. Hibbard JH, Sofaer S. Best Pract
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access to essential information and
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providers, for purposes of this rev
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information and reduces comprehensi
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Methods Topic Nomination and Develo
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Table 1. Public reporting concepts
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• The public reporting was only a
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• Key Question 2. Harms included
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were retained, but they were not as
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Data Extraction Following full text
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Data Synthesis We separated studies
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Results Organization The results of
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Overview of Effectiveness of Public
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Access restrictions. It was unclear
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o The results of two studies sugges
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Page 57 and 58: Harms (Key Question 2) • Two 52,6
Page 59 and 60: eport known as QualityCounts was pr
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Page 63 and 64: o One study found that patients tre
Page 65 and 66: condition found declines for CHF (7
Page 67 and 68: developed (HCAHPS) and public repor
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Page 75 and 76: Lab-Type Experiments The two articl
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Page 97 and 98: One study evaluated use of a Web si
Page 99 and 100: Patients. Patient reactions to publ
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Page 107 and 108: The public reporting intervention i
Page 109 and 110: that included adjustment for severa
Page 111 and 112: Key Question 6. Context Five studie
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Page 115 and 116: CAHPS results. Credibility of the r
Page 123 and 124: Long-Term Care Services Prior syste
Page 125 and 126: o Improvement in one QM (influenza
Page 127 and 128: studies that examined change and tr
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Page 147 and 148: Figure 3. Number of included quanti
Page 149 and 150: suggests the possibility that addit
Page 151 and 152: Table 8. Summary evidence table: Ef
Page 153 and 154: literature sources that we were abl
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of public reports have a wide range
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approaches to reducing bias in heal
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21. Young G. Multistakeholder regio
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60. Castle NG, Liu D, Engberg J. Th
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99. Knutson DJ, Kind EA, Fowles JB,
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141. Schneider EC, Epstein AM. Infl
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181. Scanlo DP, Chernew M, McLaughl
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222. Ketelaar NA, Faber MJ, Flottor
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Appendix A. Literature Search Datab
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CINAHL EBSCO Plus with Full Text Da
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EMBASE - Elsevier (1973-present) Da
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Public Affairs Information Service
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Full Text Review Include: Based on
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Appendix C. Included and Excluded S
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29. Castle NG, Sonon K, Antonova J.
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58. Gabel JR. When employers choose
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86. Hibbard JH, Peters E, Dixon A,
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117. Marshall M, Noble J, Davies H,
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145. Pettijohn TL, Lawrence ME. The
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174. Spranca MD, Elliott MN, Shaw R
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6. NCQA releases HEDIS 2.0 standard
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40. Pacific Business Group on Healt
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74. The effect of report cards on M
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110. MGMA addresses accuracy concer
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137. Applebaum R, Kunkel S, Wilson
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165. Barkauskas VH, Pohl JM, Benker
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193. Bindman AB, Wholey DR, Christi
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219. Bratzler DW. Development of na
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247. Caldwell B. Employers use perf
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275. Centre for R, Dissemination. P
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301. Chesanow N. Managed care 1999.
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329. Commonwealth Fund. Commission
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358. Daly JM, Jogerst GJ. Associati
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386. DeLiberty RN. Developing a pub
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412. Doty MM, Koren MJ, Sturla EL,
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439. Elliott MN, Beckett MK, Kanous
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467. Feeley TW, Fly HS, Albright H,
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494. French J. 2003 E.I. Hood Award
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522. Ginsburg PB, Kemper, N. M. Hea
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551. Graham JD. Is reporting of qua
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581. Gruber T, Rudnitsky B. Can we
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608. Hardingham L. Informed decisio
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633. Heidenreich PA, Lewis WR, LaBr
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660. Hodgson ES, Simpson L, Lannon
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689. Izakovic M. New trends in the
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718. Kakkar A, Jacobson BC. Interne
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747. Ketelaar N, Faber M, Flottorp
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772. . Importance of stratification
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800. Leonardi MJ, McGory ML, Ko CY.
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827. Livingston EH. Bariatric surge
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856. Mantone J. Massachusetts site
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882. Mazza G, Fazzi B. Five good re
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907. McKibben L, Horan T, Tokars JI
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935. Miller R, Lazar J. Public repo
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963. Morrison K. The road to JCAHO
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989. National Committee for Quality
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1017. O’Malley C. Quality measure
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1045. Peabody J. Why we love qualit
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1073. Qaseem A, Snow V, Gosfield A,
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1100. Robinowitz DL, Dudley RA. Pub
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1129. Roski J, Kim MG. Current effo
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1156. Sangl JA, Wolf LF. Role of co
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1183. Schull MJ, Guttmann A, Leaver
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1212. Shea JA, Guerra CE, Weiner J,
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1238. Simpson AG, DeGuzman PB, Barb
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1264. Sofaer S. What information do
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1292. Stewart DW, Hickson GB, Pechm
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1320. Tjia J, Field TS, Fischer SH,
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1346. Van Beek K, Duchemin S, Gersh
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1374. Weingarten JP, Jr., Fan W, Pe
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1401. Wiljer D, Bogomilsky S, Catto
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1426. Zaslavsky AM, Shaul JA, Zabor
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Appendix E. Description of Public R
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Table E1. Descriptive information a
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Table E1. Descriptive information a
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Appendix F. Method for Quality Asse
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the time periods actually prior to
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Application to Public Reporting Thi
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Table G1. Quality assessment criter
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Table G1. Quality assessment criter
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Section A Appendix H. Hospitals: Qu
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Table H1. Hospital quantitative stu
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Section B Table H2. C Hospital quan
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Author, Year (QA) Baker 2003 4 (Fai
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Author, Year (QA) Clough 2002 10 (F
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Author, Year (QA) Dranove 2003 13 (
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Author, Year (QA) Foreman 1995 16 (
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Author, Year (QA) Guru 2006 19 (Fai
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Author, Year (QA) Hibbard 2003 24 (
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Author, Year (QA) Jang 2011 28 (Fai
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Author, Year (QA) Mennemeyer 1997 3
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Author, Year (QA) Omoigui 1996 34 (
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Author, Year (QA) Pope 2009 36 (Fai
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Author, Year (QA) 9. Context: Decis
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Author, Year (QA) Vladeck 1988 42 (
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Author, Year (QA) Wuebker, 2008 45
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Table I1. Hospital qualitative stud
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Section B Table I2. Hospital qualit
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Author, Year 10. KQ3:Results 11. KQ
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Author, Year 10. KQ3:Results design
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Author, 15. Funder of Research/ Yea
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Regarding the least useful aspects,
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Section A Appendix J. Individual Pr
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Author Year (QA) Hannan 1994 21 (Go
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Author Year (QA) Mukamel 1998 33 (F
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Author Year (QA) Werner 53 2005 (Go
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Author Year (QA) Glance 2008 48 (Fa
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Author Year (QA) Hannan 1994 21 (Go
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Author Year (QA) Results: KQ1: (Hea
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Author Year (QA) Ranganathan 2009 5
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Author Year (QA) Werner 2005 53 (Go
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Author Year Barr 2008 144 1. Study
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Author Year Casalino 2007 146 1. St
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Author Year Fanjiang 2007 150 1. St
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Author Year Friedber g 2010 151 1.
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Author Year 1. Study Purpose and/or
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Author Year Longo 2003 119 1. Study
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Author Year Marshall 2006 154 Mayth
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Author Year 1. Study Purpose and/or
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Author Year Schneid er 1996 138 Con
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Author Year Schultz 2001 158 Stein
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Author Year QA Beaulieu 2002 56 Fai
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Author Year QA Chernew 2004 58 Fair
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Author Year QA Farley 2002 62 Good
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Author Year QA Hendricks 2009 66 Po
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Author Year QA 1. Study Purpose and
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Author Year QA Beaulieu 2002 56 Fai
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Author Year QA Chernew 2004 58 Fair
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Author Year QA 11. Results: KQ1: (H
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Author Year QA Farely 2002 62 Good
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Author Year QA Fowles 2000 63 Good
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Author Year QA Jung 2010 68 Good Kn
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Author Year QA 11. Results: KQ1: (H
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Author Year QA Pham 2002 73 Good 11
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Author Year QA Tae-Seale 2004 76 Fa
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Appendix M. Health Plans: Qualitati
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Author Year Farley-Short 2002 162 1
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Author Year Gabel 1998 163 1. Study
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Author Year Gibbs 1996 164 1. Study
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Author Year 1. Study Purpose 2. Geo
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Author Year Harris- Koejetin 2000 1
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Author Year Hibbard 1997 171 1. Stu
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Author Year Hibbard 2001 178 Hibbar
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Author Year Paulsbo 2007 183 Peters
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Author Year Rosenthal 2007 186 1. S
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Author Year Scanlon 2001 188 1. Stu
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Author Year Spranca 2000 190 1. Stu
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Author Year Teleki 2007 192 1. Stud
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Author Year Uhrig 2006 194 1. Study
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Section A Appendix N. Long-Term Car
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Author Year Jung 2010 85 Konetzka 2
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Author Year Werner 2009a 92 Werner
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Author Year Zinn 2010 99 1. Study P
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Author Year Castle 2007 79 Cont. 11
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Author Year Castle 2010 81 11. Resu
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Author Year Jung 2010 85 11. Result
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Author Year Mukamel 2008 86 Mukamel
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Author Year Park 2011 b 90 11. Resu
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Author Year Werner 2009 b 93 11. Re
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Author Year Werner 2010 94 Werner 2
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Author Year Zinn 2005 97 11. Result
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Author Year Zinn 2010 99 11. Result
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Appendix O. Long-Term Care: Qualita
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Author Year Castle 2005 197 1. Stud
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Author Year Gerteis 2007 198 1. Stu
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References 1. AHRQ. Methods Guide f
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36. Pope DG. Reacting to rankings:
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77. Wedig GJ, Tai-Seale M. The effe
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118. Laschober M, Maxfield M, Felt-
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157. Pettijohn TL, Lawrence ME. The
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198. Gerteis M, Gerteis JS, Newman
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