5. Public Reporting as a Quality Improvement Strategy

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Figure 2. Study flow diagram a Four quantitative studies report results about individual clinicians and hospitals and therefore appear in both categories here. b Three articles included in this count reported the results of one qualitative study; two articles reported results of one other study. 23
Overview of Effectiveness of Public Reporting as a Quality Improvement Strategy The following summary of the results is organized by Key Question and seeks to identify cross cutting trends and implications. These are also included in the Discussion section and the summary table at the end of the document. However this does not reflect how the analyses were originally compiled. Research studies of public reporting concern reports and the resulting changes in behavior and outcomes for a specific health care setting. Our analyses followed the literature and presents the results by setting, but the other reason we organized the detailed reporting of the results in later sections by setting was because we believe that the inherent differences in the nature of the decisions (e.g., selecting a cardiac surgeon vs. selecting a nursing home) merit careful consideration when attempting to judge effectiveness. Overall we found that both the amount of evidence and the results varied by Key Questions and outcome as well as by setting. Here we provide our conclusions as well as the strength of evidence assessment for that conclusion followed by general comments and the relevant key points for each setting. These key points are repeated in the results section for each setting. The key points for hospitals are also divided into those resulting from studies of cardiac care and those from non cardiac care (that is any hospital care that is not cardiac surgery or care for a cardiac condition) as this is the structure we used to organize the large number of articles about hospitals. The strength of evidence assessments are not repeated in the sections by health care setting, they are presented only here and in the summary table in the Discussion section. This is because this assessment was made only across settings. Summary of Results by Key Question Key Question 1 Does public reporting result in improvements in the quality of health care (including improvements in health care delivery structures, processes or patient outcomes)? Overall Findings Mortality. Public Reporting was associated with a small decline in mortality after controlling for trends in reductions in mortality (19 studies, moderate strength of evidence). Quality and process indicators (e.g. Consumer Assessment of Healthcare Providers and Systems [CAHPS],Healthcare Effectiveness Data and Information Set [HEDIS], and Nursing Home [NH] Compare). Most studies found that public reporting is associated with improvement in quality and process indicators, though this varies across specific measures (19 studies, high strength of evidence). Mortality was often the focus in studies of hospitals and was also the primary outcome in one study of individual providers. Most of the studies find a decrease in mortality, though these results are not uniformly consistent and many questions about the appropriateness of the comparisons (both groups and risk adjustment methods) are an ongoing subject of debate. In studies of health plans and long term care, the outcomes studied most often were the quality measures for more specific outcomes such as pain, pressure ulcers, and satisfaction with care. In general these studies find that public reporting has a positive impact on the quality measures 24
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 and 14: • Outcomes (specified for each Ke
Page 15 and 16: Methods A Technical Expert Panel fo
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: Results Organization The results of
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
Page 65 and 66: condition found declines for CHF (7
Page 67 and 68: developed (HCAHPS) and public repor
Page 69 and 70: Key Question 6. Context Two studies
Page 71 and 72: • Survey responses of hospitals i
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Page 75 and 76: Lab-Type Experiments The two articl
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Page 91 and 92: Individual Clinicians and Outpatien
Page 93 and 94: public reports influenced the contr
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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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Table 5. Summary of evidence: publi
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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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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 Rosenthal 2007 186 1. S
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Author Year Scanlon 2001 188 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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