5. Public Reporting as a Quality Improvement Strategy

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Figure A. Analytic framework Note: Dotted lines indicate relationships between intermediate outcomes and ultimate improvement in the quality of care. KQ = Key Question; QI = quality improvement. ES-5
Methods A Technical Expert Panel for this evidence report was involved in refining the definition of public reporting to be used for this review, and also contributed to developing and finalizing the Key Questions and the analytic framework. This group included clinicians, researchers, producers of public reports, and consumer advocates. Experts in public reporting and decisionmaking and individuals representing stakeholder and user communities were invited to provide external peer review of this review; AHRQ and an associate editor also provided comments. The draft report was posted for public comment for 28 days. We conducted literature searches for both prior reviews and individual studies in MEDLINE ® , Embase ® , EconLit, PsychINFO ® , Business Source ® Premier, CINAHL ® (Cumulative Index of Nursing and Allied Health Literature), PAIS (Public Affairs Information Services), The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), National Health Service Economic Evaluation Database (NHS EED), and Health Economic Evaluations Database (HEED). The Grey Literature Report database maintained by the New York Academy of Medicine and AARP Ageline were searched for additional studies and reports. The searches included studies published or reported between January 1980 and December 2011. Research studies were included if they conformed to the definition of public reporting (see above) and PICOTS and addressed at least one of the Key Questions. Studies were excluded if an English abstract was not available for a non–Englishlanguage article. At the title and abstract triage phase, we did not exclude any study based solely on study design if it met other inclusion criteria. At the full-text review stage, we identified the designs of the studies that met all other criteria, and trials and observational studies that contained empirical data on an outcome that corresponded to a stated Key Question were retained for both abstraction and quality assessment. Qualitative studies, descriptive surveys, and lab-type experiments were also retained for abstraction if they addressed a Key Question or reported outcomes that were necessary but not sufficient precursors to the outcomes in the stated Key Questions (e.g., awareness of reports; comprehension of content; attitudes toward public reporting, including specific types of presentation; and intention to use). However, these studies were not assessed for quality and their abstraction was abbreviated. Qualitative studies are reported in separate evidence tables and are summarized separately at the end of each results section for each health care setting in the full report. Since they did not measure the outcomes in the Key Questions, they are also not included in the strength-of-evidence assessments. A subset of titles and abstracts were triaged by all reviewers to confirm consistency. The remainder were divided among the reviewers and triaged, with a followup review of all exclusions. At the full-text stage, all articles were reviewed by two of the three principal reviewers and inclusion/exclusion conflicts were resolved through discussion and consensus. Following full-text review, we extracted data from all included studies. Our assessments of the quality of individual studies are based on the recommendations in the chapter titled “Assessing the Risk of Bias of Individual Studies When Comparing Medical Interventions” in the AHRQ Methods Guide for Effectiveness and Comparative Effectiveness Reviews (hereafter, Methods Guide). 13,14 We selected criteria for quality assessment of individual included studies that were appropriate for this topic. These criteria were used by two raters, who independently rated each article on these six criteria and made an overall assessment of good, fair, or poor based on definitions from the Methods Guide. After the ratings were ES-6
Page 1 and 2: Evidence Report/Technology Assessme
Page 3 and 4: This report is based on research co
Page 5 and 6: Acknowledgments We would like to ac
Page 7 and 8: Public Reporting as a Quality Impro
Page 9 and 10: Tables Table A. Summary Evidence Ta
Page 11 and 12: and using reports and other decisio
Page 13: • Outcomes (specified for each Ke
Page 17 and 18: setting), and the strength of the b
Page 19 and 20: Table A. Summary evidence table: ef
Page 21 and 22: was at the time the included studie
Page 23 and 24: 6. Hibbard JH, Sofaer S. Best Pract
Page 25 and 26: access to essential information and
Page 27 and 28: providers, for purposes of this rev
Page 29 and 30: information and reduces comprehensi
Page 31 and 32: Methods Topic Nomination and Develo
Page 33 and 34: Table 1. Public reporting concepts
Page 35 and 36: • The public reporting was only a
Page 37 and 38: • Key Question 2. Harms included
Page 39 and 40: were retained, but they were not as
Page 41 and 42: Data Extraction Following full text
Page 43 and 44: Data Synthesis We separated studies
Page 45 and 46: Results Organization The results of
Page 47 and 48: Overview of Effectiveness of Public
Page 49 and 50: Access restrictions. It was unclear
Page 51 and 52: o The results of two studies sugges
Page 53 and 54: Key Question 5 What characteristics
Page 55 and 56: Long-term care • Studies that exa
Page 57 and 58: Harms (Key Question 2) • Two 52,6
Page 59 and 60: eport known as QualityCounts was pr
Page 61 and 62: Table 1. Study findings: hospital c
Page 63 and 64: o One study found that patients tre
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condition found declines for CHF (7
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developed (HCAHPS) and public repor
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Key Question 6. Context Two studies
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• Survey responses of hospitals i
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activity would influence hospital c
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Lab-Type Experiments The two articl
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Table 3. Summary of evidence: publi
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Individual Clinicians and Outpatien
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public reports influenced the contr
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New York State to trends in other S
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One study evaluated use of a Web si
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Patients. Patient reactions to publ
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Table 4. Summary of evidence: quali
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Table 4. Summary of evidence: Quali
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Health Plans Rating and reporting o
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The public reporting intervention i
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that included adjustment for severa
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Key Question 6. Context Five studie
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about patient-physician relationshi
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CAHPS results. Credibility of the r
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Long-Term Care Services Prior syste
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o Improvement in one QM (influenza
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studies that examined change and tr
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Table 6. Study findings: change in
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ehospitalizations for these patient
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improvements in the pain measure we
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Werner et al. 107 2012 included ext
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Table 7. Summary of evidence: long-
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Figure 3. Number of included quanti
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suggests the possibility that addit
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Table 8. Summary evidence table: Ef
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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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5. Public Reporting as a Quality Improvement Strategy

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