Hospital Report Cards: Intent, Impact, and Illusion

Partnering with consumers in the public reporting of quality of care: review of the Victorian quality of care reports

Objective The aim of the present study was to investigate whether the content of annual Victorian quality of care reports had an increased consumer participation focus following the introduction of the National Safety and Quality Health Service (NSQHS) Partnering with Consumers standard. Methods A mixed-methods approach comprising a comparative descriptive observational study design with quantitative data analysis was used. Nine large Victorian metropolitan public health services’ annual quality of care reports from 2011 and 2014 were analysed using a newly devised analysis framework consisting of elements of the NSQHS ‘Partnering with Consumers’ standard and minimal requirements for Quality of Care reporting by the Department of Health and Human Services. Results Of the nine 2014 quality of care reports, in only three were total scores higher compared with scores in the 2011 reports; in one of the 2014 reports, the total scores remained the same, and in the remaining five reports total scores were lower than in the 2011 reports. Overall, there was an improved total score for the 2014 reports compared with the 2011 reports, corresponding to a higher consumer participation focus. Conclusion Overall, the present study demonstrated mixed findings and, in some cases, lower scores for the 2014 reports, which was after the introduction of the Partnering with Consumers NSQHS standard, compared with the 2011 reports. Overall, there is future scope to enhance the degree of consumer participation evident within the quality of care reports. What is known about the topic? Partnering with consumers has been associated with improved clinical outcomes, decreased readmission rates and rates of hospital-acquired infections, and improved adherence to treatment recommendations and health literacy. Engaging consumers has been recognised as a means to increase the accessibility and appropriateness of healthcare to individuals. Public reporting is a tool through which health services communicate with and engage their consumers in order to improve the quality of care they provide, and is a key element in Australia of the NSQHS Partnering with Consumers standard. What does the paper add? This paper links the principles of consumer participation with public reporting. The paper highlights the potential for healthcare organisations to use their public reporting media to engage with consumers and communicate about the quality of care they deliver. What are the implications for practitioners? The unexpected findings of a lower emphasis on consumer participation suggests the need for Victorian health services to review the purpose and processes for developing the publicly reported quality of care reports in order to improve their compliance.

Mandatory quality reports in Germany from the hospitals' point of view: a cross-sectional observational study

Background

Public reporting of hospital quality is to enable providers, patients and the public to make comparisons regarding the quality of care and thus contribute to informed decisions. It stimulates quality improvement activities in hospitals and thus positively impacts treatment results. Hospitals often use publicly reported data for further internal or external purposes.

As of 2005, German hospitals are obliged to publish structured quality reports (QR) every two years. This gives them the opportunity to demonstrate their performance by number, type and quality in a transparent way. However, it constitutes a major burden to hospitals to generate and publish data required, and it is yet unknown if hospitals feel adequately represented and at the same time consider the effort appropriate.

This study assesses hospital leaders’ judgement about the capability of QR to put legally defined aims effectively and efficiently into practice. It also explores the additional purposes hospitals use their QR for.

Methods

In a cross-sectional observational study, a representative random sample out of 2,064 German hospitals (N=748) was invited to assess QR via questionnaire; 333 hospitals participated. We recorded the suitability of QR for representing number, type and quality of services, the adequacy of cost and benefits (6-level Likert scales) and additional purposes QR are used for (free text question). For representation purposes, the net sample was weighted for hospital size and hospital ownership (direct standardization). Data was analyzed descriptively and using inferential statistics (chi-2 test) or for the purpose of generating hypotheses.

Results

German hospitals rated the QR as suitable to represent the number of services but less so for the type and quality of services. The cost-benefit ratio was seen as inadequate. There were no significant differences between hospitals of different size or ownership.

Public hospitals additionally used their reports for mostly internal purposes (e.g. comparison with competitors, quality management) whereas private ones used them externally (e.g. communication, marketing) (p=0.024, chi-2 test, hypotheses-generating level).

Conclusions

German hospitals consider the mandatory QR as only partially capable to put the legally defined aims effectively and efficiently into practice. In order for public reporting to achieve its potentially positive effects, the QR must be more closely aligned to the needs of hospitals.

Communicating quality of care information to physicians: a study of eight presentation formats

OBJECTIVE

Non-hospital based physicians usually counsel their patients which hospital to choose. Our aim was to determine which formats for presenting quality of care data are preferred by physicians.

METHODS

300 randomly recruited non-hospital based physicians participated in a survey. We created eight presentation formats which varied in terms of information aggregation and usage of evaluative cues. Participants rated clarity, comprehensibility, information content, acceptance, and preference of the presentation formats. Additionally, we tested physicians' comprehension of the formats.

RESULTS

Physicians' ratings of the formats differed significantly (p<0.001). Formats combining numeric information and evaluative cues performed best in terms of information content, comprehensibility and preference. Comprehension of presentation formats also differed (p<0.001). Even though physicians' accuracy of interpreting "Simple Star Rating" was best a majority of participants accepted only formats that contained detailed numerical information (p<0.001).

CONCLUSION

In order to support physicians' use of quality of care information in counseling patients, report cards should depict indicator values in a format that combines actual indicator values with evaluative cues.

PRACTICE IMPLICATIONS

If authors of comparative hospital quality reports apply the results of our study in designing reports, the results may increase physicians' use of comparative performance reports in their counseling of patients.

Using discrete choice experiment to elicit doctors' preferences for the report card design of diabetes care in Taiwan - a pilot study

OBJECTIVES

Little is known about doctors' preferences regarding public report card design. Taiwan just announced the first diabetes report card on April 2008. The aim of this study was to investigate the Diabetes Mellitus (DM) providers' preferences towards four report card attributes: update frequency, risk adjustment, content information and display format.

METHODS

A discrete choice questionnaire was mailed to hospital and primary care doctors in the northern part of Taiwan, with 221 study targets. The response rate was 29%.

RESULTS

Using random effect logistic regression, doctors' preference attribute rankings were risk adjustment for patients (44.7%), content information (25.2%), display format (18.3%) and update frequency (11.8%). One-year update frequency, risk adjustment, detailed scores of technical quality and interpersonal quality and bar chart display were the most important items noted in our survey.

CONCLUSIONS

This is the first study to investigate provider's preferences for a diabetes report card. It enables the policy maker to clearly see the implication of trade-offs between different choices when designing a report card that doctors will like. Our findings suggest that doctors do not favour the 'less is more' principle, or the higher frequency of updates that patients may prefer. Rather, our findings suggest that risk adjustment and more information content are the most important factors for doctors. Future studies should use discrete choice experiment on different aspects of report card design, such as vulnerable patients or health care administrations.

Regulation, measurements and incentives. The experience in the US and UK: does context matter?

Since the 1990s the US and UK healthcare systems have increasingly sought to measure the quality of services in order to stimulate improvement and publish the results. Despite the very different healthcare systems, there are some striking similarities in the results of these schemes. In both countries information that creates the threat of reputational damage and the possibility of gaining kudos is particularly effective in stimulating a response. However, these responses may be perverse: gaming, falsifying of data and measurement fixation have all been uncovered. In the UK context, information is closely aligned to the regulatory and performance management framework, and there should be a role for the new Care Quality Commission in the emerging 'information landscape' of the NHS in England.