5. Public Reporting as a Quality Improvement Strategy

Author, Year
(QA)
Baker 2003 4
(Fair)
Bridgewater
2007 6
(Good)
Carey 2006 7
(Fair)
9. Context:
Decisionmaker
Characteristics
Patients and Payers
have access to the data.
Motivation to have better
outcomes and possibly
to avoid operating on
high-risk patients
10. Context:
Type of
Decision/Choice 11. Results: KQ1: (Health Care Outcomes) 12. Results: KQ2 (Harms)
Hospital selection
for future use.
Patients selected
by
provider/surgeon.
CHF: absolute decline 1.4% (95% CI, -2.5 to
-0.1)
COPD: absolute decline 1.6% (95% CI, -2.8
to 0.0)
Stroke: absolute increase 4.3% (95% CI,
1.8% to 7.1)
Hospital outlier status was not significantly
related to changes in risk-adjusted 30-day
mortality. Between 1991 and 1997, the
absolute change in risk-adjusted 30-day
mortality at “average” hospitals was -0.5%
(95%CI: -1.8-1.0%). Risk adjusted mortality
declined only slightly at hospitals classified
as “below average” (-0.8%, 95%CI: -2.9-
1.8%) and at hospitals classified as “worst” (-
0.4%; 95%CI: -2.3-1.7)
Observed Mortality decreased from 2.4% in
1997-98 to 1.8% in 2004-5 (p=0.014)
Expected Mortality increased from 3.0% in
1997-8 to 3.5% in 2004-5 (p