5. Public Reporting as a Quality Improvement Strategy

Appendix P. Strength of Evidence
Table P1. Strength of evidence assessment by key questions
Key Question
Outcome
Key Question 1:
Mortality
Quality and
process
indicators
Key Question 2:
Setting
(Number of studies)
Hospitals(18)
Individual Clinicians (1)
Hospitals (5)
Health Plans (5)
Long-term Care (9)
Risk of
Bias Consistency Directness Precision
P-1
Overall
Strength of
Evidence
Medium Inconsistent Direct Imprecise Moderate
Medium Consistent Indirect Imprecise High
Mortality Hospitals (1) - - - - Insufficient
Inappropriate
diagnosis
treatment
Access
restrictions
Unintended
provider behavior
Key Question 3:
Provider actions
Key Question 4:
Selection (market
share/volume)EF
FECT
Key Question 5:
Mode and tone of
message
Accuracy and
usefulness
Key Question 6:
Competitive
market
Baseline
performance
Nursing home
characteristic
Patient
characteristics/
subgroups
Variation in
quality
Hospitals (1) - - - - Insufficient
Hospital (8)
Individual Clinicians(2)
Long-term Care (2)
Individual Clinicians (1)
Health Plans (2)
Long-term Care (2)
Hospitals (4)
Individual Clinicians(1)
Long- term Care (5)
Hospitals (15)
Individual Clinicians (9)
Health Plans (17)
Long-term Care (6)
Medium Inconsistent Indirect Imprecise Low
Low Consistent Indirect Imprecise Moderate
Medium Consistent Direct Imprecise Moderate
Medium Inconsistent Indirect Imprecise Moderate
Individual Clinicians (1) - - - - Insufficient
Individual Clinicians (1) - - - - Insufficient
Hospitals (2)
Long term care (5)
Health Plans (2)
Long-term Care (3)
Medium Consistent Direct Precise High
Medium Consistent Direct Precise High
Long-term Care (6) Medium Inconsistent Indirect Imprecise Low
Health Plans (1)
Individual Clinicians (2)
Medium Inconsistent Indirect Imprecise Low
Health Plans (1) - - - = Insufficient