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Song Y, Do YK. Patient experience and nurse staffing level in South Korea. Int J Qual Health Care 2024; 36:mzae038. [PMID: 38706179 DOI: 10.1093/intqhc/mzae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/31/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024] Open
Abstract
Patient experience has recently become a key driver for hospital quality improvement in South Korea, marked by the introduction of the Patient Experience Assessment (PXA) within its National Health Insurance in 2017. While the PXA has garnered special attention from the media and hospitals, there has been a lack of focus on its structural determinants, hindering continuous and sustained improvement in patient experience. Given the relatively low number of practicing nurses per 1000 population in South Korea and the significant variation in nurse staffing levels across hospitals, the staffing level of nurses in hospitals could be a crucial structural determinant of patient experience. This study examines the association between patient experience and hospital nurse staffing levels in South Korea. We used individual- and hospital-level data from the 2019 PXA, encompassing 7250 patients from 42 tertiary hospitals and 16 235 patients from 109 non-tertiary general hospitals with 300 or more beds. The dependent variables were derived from the complete set of 21 proper questions on patient experience in the Nurse and other domains. The main explanatory variable was the hospital-level Nurse Staffing Grade (NSG), employed by the National Health Insurance to adjust reimbursement to hospitals. Multilevel ordered/binomial logistic or linear regression was conducted accounting for other hospital- and patient-level characteristics as well as acknowledging the nested nature of the data. A clear, positive association was observed between patient experience in the Nurse domain and NSG, even after accounting for other characteristics. For example, the predicted probability of reporting the top-box category of "Always" to the question "How often did nurses treat you with courtesy and respect?" was 70.3% among patients from non-tertiary general hospitals with the highest NSG, compared to 63.1% among patients from their peer hospitals with the lowest NSG. Patient experience measured in other domains that were likely to be affected by nurse staffing levels also showed similar associations, although generally weaker and less consistent than in the Nurse domain. Better patient experience was associated with higher hospital nurse staffing levels in South Korea. Alongside current initiatives focused on measuring and publicly reporting patient experience, strengthening nursing and other hospital workforce should also be included in policy efforts to improve patient experience.
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Affiliation(s)
- Yeongchae Song
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
- Review and Assessment Research Department, Health Insurance Review and Assessment Service, Wonju 26465, Republic of Korea
| | - Young Kyung Do
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
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Fernandes CJ, Gautham KS. Organization of care of infants with congenital diaphragmatic hernia-Building a high-functioning CDH program. J Perinatol 2024; 44:339-347. [PMID: 37798339 DOI: 10.1038/s41372-023-01789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/09/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
Infants born with congenital diaphragmatic hernia have high mortality and morbidity and require coordinated multidisciplinary care for optimal outcomes. Over the past several decades numerous articles have been published on the technical aspects of the care of these patients demonstrating both the variation in management across institutions as well as the desirability and need for standardization of care. Unfortunately, none have focused on the organization of care for CDH patients encompassing the range from early prenatal diagnosis to long-term postnatal care. However, to achieve optimal care and optimal outcomes, it is important to not only have excellent technical surgical and medical care but also to have an organized, systematic, and purposefully designed program for the delivery of healthcare to infants with this condition. In this article, based on our experience and drawing on general principles of building clinical programs, we describe the important elements of an ideal CDH program.
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Affiliation(s)
- Caraciolo J Fernandes
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA.
| | - Kanekal S Gautham
- Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, FL, USA
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Kast K, Otten SM, Konopik J, Maier CB. Web-Based Public Reporting as a Decision-Making Tool for Consumers of Long-Term Care in the United States and the United Kingdom: Systematic Analysis of Report Cards. JMIR Form Res 2023; 7:e44382. [PMID: 38096004 PMCID: PMC10755662 DOI: 10.2196/44382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/09/2023] [Accepted: 11/22/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Report cards can help consumers make an informed decision when searching for a long-term care facility. OBJECTIVE This study aims to examine the current state of web-based public reporting on long-term care facilities in the United States and the United Kingdom. METHODS We conducted an internet search for report cards, which allowed for a nationwide search for long-term care facilities and provided freely accessible quality information. On the included report cards, we drew a sample of 1320 facility profiles by searching for long-term care facilities in 4 US and 2 UK cities. Based on those profiles, we analyzed the information provided by the included report cards descriptively. RESULTS We found 40 report cards (26 in the United States and 14 in the United Kingdom). In total, 11 of them did not state the source of information. Additionally, 7 report cards had an advanced search field, 24 provided simplification tools, and only 3 had a comparison function. Structural quality information was always provided, followed by consumer feedback on 27 websites, process quality on 15 websites, prices on 12 websites, and outcome quality on 8 websites. Inspection results were always displayed as composite measures. CONCLUSIONS Apparently, the identified report cards have deficits. To make them more helpful for users and to bring public reporting a bit closer to its goal of improving the quality of health care services, both countries are advised to concentrate on optimizing the existing report cards. Those should become more transparent and improve the reporting of prices and consumer feedback. Advanced search, simplification tools, and comparison functions should be integrated more widely.
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Affiliation(s)
- Kristina Kast
- Chair of Health Care Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Sara-Marie Otten
- Chair of Health Care Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Jens Konopik
- Chair of Health Care Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Claudia B Maier
- School of Public Health, Universität Bielefeld, Bielefeld, Germany
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Chen M, Zhang X, Liu C, Chen H, Wang D, Liu C. Effects of public reporting of prescription indicators on patient choices: evidence from propensity scores matching. Front Pharmacol 2023; 14:1110653. [PMID: 37876730 PMCID: PMC10591321 DOI: 10.3389/fphar.2023.1110653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
Background: Public reporting on health providers' performance (PRHPP) is increasingly used for empowering patients. This study aimed to test the effect of PRHPP using the theory of the consumer choice model. Methods: The study was conducted in 10 primary care institutions in Hubei province, China. Information related to the percentage of prescriptions requiring antibiotics, the percentage of prescriptions requiring injections, and average costs per prescription for each prescriber was calculated, ranked and displayed in a public place on a monthly basis. A questionnaire survey was undertaken on 302 patients 10 months after the initiation of the PRHPP, tapping into patient awareness, understanding, perceived value and use of the information in line with the theory of the consumer choice model. The fitness of data with the model was tested using structural equation modelling. The patients who were aware of the PRHPP were compared with those who were unaware of the PRHPP. The propensity score method (considering differences between the two groups of patients in age, gender, education, health and income) was used for estimating the effects of the PRHPP. Results: About 22% of respondents were aware of the PRHPP. Overall, the patients showed limited understanding, perceived value and use of the disclosed information. The data fit well into the consumer choice model. Awareness of the PRHPP was found to be associated with increased understanding of the antibiotic (p = 0.028) and injection prescribing indictors (p = 0.030). However, no significant differences in perceived value and use of the information (p > 0.097) were found between those who were aware and those who were unaware of the PRHPP. Conclusion: Although PRHPP may improve patient understanding of the prescribing performance indicators, its impacts on patient choices are limited due to low levels of perceived value and use of information from patients. Additional support is needed to enable patients to make informed choices using the PRHPP.
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Affiliation(s)
- Manli Chen
- School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei, China
- Research Center for the Development of Traditional Chinese Medicine, Key Research Institute of Humanities and Social Sciences of Hubei Province, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Haihong Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Dan Wang
- School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei, China
- Research Center for the Development of Traditional Chinese Medicine, Key Research Institute of Humanities and Social Sciences of Hubei Province, Wuhan, China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Colais P, Pinnarelli L, Mataloni F, Giordani B, Duranti G, D’Errigo P, Rosato S, Seccareccia F, Baglio G, Davoli M. The National Outcomes Evaluation Programme in Italy: The Impact of Publication of Health Indicators. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811685. [PMID: 36141957 PMCID: PMC9517347 DOI: 10.3390/ijerph191811685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 06/12/2023]
Abstract
In Italy the National Outcomes Evaluation Programme, (P.N.E.) is the most comprehensive comparative evaluation of healthcare outcomes at the national level. The aim of this report is to describe the P.N.E. and some of the most relevant results achieved. The P.N.E. analysed 184 indicators on quality of care in 2015-2020 period. The data sources are the Italian Health Information Systems. The indicators reported were: proportion of surgery within 2 days after hip fracture in the elderly (HF), 30-day mortality after hospital admission for acute myocardial infarction (AMI), proportion of reoperations within 90 days of breast-conserving surgery and proportion of primary caesarean deliveries. Risk adjustment methods were used to take into account patients' characteristics. From 2010 to 2020 the proportion of interventions within 2 days after HF increased from 31.3% to 64.6%, the AMI 30-day mortality decreased from 10.4% to 8.3%, the proportion of reinterventions within 90 days of breast-conserving surgery decreased from 12.0% to 5.9% and the proportion of primary caesarean deliveries decreased from 28.4% to 22.7%. Results by area of residence showed heterogeneity of healthcare quality. We observed a general improvement in different clinical areas not always associated with a reduction of heterogeneity among areas of residence.
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Affiliation(s)
- Paola Colais
- Department of Epidemiology, Lazio Regional Health Service, 00147 Rome, Italy
| | - Luigi Pinnarelli
- Department of Epidemiology, Lazio Regional Health Service, 00147 Rome, Italy
| | - Francesca Mataloni
- Department of Epidemiology, Lazio Regional Health Service, 00147 Rome, Italy
| | - Barbara Giordani
- Research and International Relations Unit, Italian National Agency for Regional Healthcare Services (AGENAS), 00187 Rome, Italy
| | - Giorgia Duranti
- Research and International Relations Unit, Italian National Agency for Regional Healthcare Services (AGENAS), 00187 Rome, Italy
| | - Paola D’Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Giovanni Baglio
- Research and International Relations Unit, Italian National Agency for Regional Healthcare Services (AGENAS), 00187 Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, 00147 Rome, Italy
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Grade pending: the effect of the New York City restaurant sanitary grades inspection program on Salmonellosis. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01384-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Quality of End-of-Life Cancer Care in Canada: A 12-Year Retrospective Analysis of Three Provinces' Administrative Health Care Data Evaluating Changes over Time. Curr Oncol 2021; 28:4673-4685. [PMID: 34898554 PMCID: PMC8628746 DOI: 10.3390/curroncol28060394] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
This retrospective cohort study of cancer decedents during 2004-2015 examined end-of-life cancer care quality indicators (QIs) in the provinces of British Columbia (BC), Ontario, and Nova Scotia (NS). These included: emergency department use, in-patient hospitalization, intensive care unit admissions, physician house calls, home care visits, and death experienced in hospital. Ontario saw the greatest 12-year decrease in in-hospital deaths from 52.8% to 41.1%. Hospitalization rates within 30 days of death decreased in Ontario, increased in NS, and remained the same in BC. Ontario's usage of aggressive end-of-life measures changed very little, while BC increased their utilization rates. Supportive care use increased in both NS and Ontario. Those who were male or living in a lower income/smaller community (in Ontario) were associated with a decreased likelihood of receiving supportive care. Despite the shift in focus to providing hospice and home care services, approximately 50% of oncology patients are still dying in hospital and 11.7% of patients overall are subject to aggressive care measures that may be out of line with their desire for comfort care. Supportive care use is increasing, but providers must ensure that Canadians are connected to palliative services, as its utilization improves a wide variety of outcomes.
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Chalil Madathil K, Greenstein JS. Designing comprehensible healthcare public reports: An investigation of the use of narratives and tests of quality metrics to support healthcare public report sensemaking. APPLIED ERGONOMICS 2021; 95:103452. [PMID: 33957305 DOI: 10.1016/j.apergo.2021.103452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/10/2021] [Accepted: 04/18/2021] [Indexed: 06/12/2023]
Abstract
A key challenge for designers of healthcare public reports is the development of a presentation format that accurately communicates the variability in the quality of care among healthcare systems. This study conducted in the United States explored whether presenting public report information within narratives and with tests of healthcare quality metrics supported the public report sensemaking process. The study involved 200 participants and employed a 2 (public report information presented in the standard format, presented within a narrative) * 2 (no tests of quality metrics added to standard report, metrics tests added) between-subjects experimental design. The participants viewed the scenario of a patient looking for dialysis facility-related information. They were then asked which dialysis facility they would choose for their care and their level of confidence in their choice. Subsequently, a knowledge quiz evaluating how the participants interpreted the information presented to them, the NASA-TLX workload survey, and a usability questionnaire were administered. The results showed that the probability of choosing the better facility from the perspective of the quality measures included in the report changed from 0.69 to 0.89 when information was presented within a narrative rather than with the standard public report format. The results also found a significantly higher comprehension score (M = 54.58, SD = 18.51) when information was presented within the narrative than when presented in the standard public report format (M = 44.57, SD = 25.13). When information was presented to the participants within a narrative, the narrative may have enabled the participants to visualize themselves as the person depicted in the narrative and this may have increased the perceived relevance of the quality measures. Total workload, mental demand and perceived usability were higher when information was presented within the narrative than when presented in the standard format. The high workload and mental demand may be due to the stress placed on the information processing channels while reading a narrative and the effort expended to relate it to the quality measures. They may also be markers of more deliberative decision making facilitated by the narratives. No significant effect of tests of quality metrics was found on the dependent variables of choice of the better healthcare facility, comprehension, and usability. There was also no significant effect of quality metrics tests on overall workload. However, the effect of quality metrics tests on the mental demand subscale of NASA-TLX was significant. Mental demand was higher without quality metrics tests than with quality metrics tests. No significant interaction was found between the two independent variables on the dependent variables of choice of the better healthcare facility, comprehension, workload, and usability. It is recommended that narratives be used to present public report information to support informed healthcare decisions.
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Affiliation(s)
- Kapil Chalil Madathil
- Department of Industrial Engineering, Clemson University, 110 Freeman Hall, Clemson, SC, 29634, USA; Glenn Department of Civil Engineering, Clemson University, 116 Lowry Hall, Clemson, SC, 29634, USA.
| | - Joel S Greenstein
- Department of Industrial Engineering, Clemson University, 110 Freeman Hall, Clemson, SC, 29634, USA
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Ndumele CD, Cohen MS, Solberg M, Lollo A, Wallace J. Characterization of US Hospital Advertising and Association With Hospital Performance, 2008-2016. JAMA Netw Open 2021; 4:e2115342. [PMID: 34213558 PMCID: PMC8254134 DOI: 10.1001/jamanetworkopen.2021.15342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Hospital advertising has been touted as a tool to improve consumer decision-making, but little is known about its association with objective measures of hospital quality. OBJECTIVE To document recent trends in hospital advertising in the US and examine the association between concurrent measures of hospital advertising and quality. DESIGN, SETTING, AND PARTICIPANTS Retrospective cross-sectional study of all general acute care hospitals operating in the US between January 2008 and December 2016. Data were analyzed from December 6, 2019, to July 15, 2020. EXPOSURE Annualized advertising spending for each hospital as measured by a market research firm. MAIN OUTCOMES AND MEASURES Four composites of hospital performance from the Centers for Medicare & Medicaid Services Hospital Compare database were used: risk-standardized mortality rate, risk-standardized readmission rate, Consumer Assessment of Healthcare Providers & Systems (CAHPS) Overall Patient Experience Rating (scale of 1-5; higher scores indicate a more positive patient experience rating), and overall 5-star rating. Linear models adjusted for hospital bed size, hospital revenue, and geographic census region. RESULTS The study sample included, on average, 4569 general acute care hospitals per year between 2008 and 2016. During this time, approximately half of acute care hospitals (2239 of 4569 [49%]) advertised their services to consumers and spent a total of $3.39 billion. Relative to hospitals that never advertised, advertising hospitals were more likely to be nonprofit facilities (mean [SD], 66% [47%] vs 51% [50%]; P < .001), had larger bed sizes (mean [SD], 234.3 [210.7] beds vs 84.8 [110.6] beds; P < .001), and had higher net incomes (mean [SD], $17 800 000 [$49 000 000] vs $134 099 [$51 600 000]; P < .001). There was no observed association between hospital advertising and performance. For example, hospitals that advertised had a mean (SD) CAHPS 5-star rating of 3.2 (0.9) stars compared with 3.3 (1.0) stars among hospitals that did not advertise, an insignificant difference (P = .92). We observed no difference in performance between advertising and nonadvertising hospitals in 30-day readmission rates (mean [SD], 15.5% [0.8%] vs 15.6% [1.0%]; P = .25), mortality rates (mean [SD], 12.7% [4.0%] vs 12.0% [4.1%]; P = .46), and overall 5-star hospital ratings (mean [SD], 3.1 [0.8] stars vs 3.0 [0.9] stars; P = .50). A significant difference was observed in adjusted mortality rates across terciles of advertising spending, with lower mortality rates for the hospitals with higher ad spending (2016, mean [SD] mortality composite for hospitals in the highest tercile, 11.2% [4.2%] vs hospitals in the middle tercile, 12.0% [3.8%], and for hospitals in the lowest tercile, 12.7% [4.1%]; P = .003). CONCLUSIONS AND RELEVANCE The results of this cross-sectional study suggest that the amount hospitals spent on direct-to-consumer advertising was not associated with publicly reported measures of hospital quality; instead, hospital advertising spending was higher for financially stable hospitals with higher net incomes.
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Affiliation(s)
- Chima D. Ndumele
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | | | | | - Anthony Lollo
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Jacob Wallace
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Ouayogodé MH, Schnier KE. Patient selection in the presence of regulatory oversight based on healthcare report cards of providers: the case of organ transplantation. Health Care Manag Sci 2021; 24:160-184. [PMID: 33417173 PMCID: PMC7791538 DOI: 10.1007/s10729-020-09530-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 10/27/2020] [Indexed: 11/13/2022]
Abstract
Many healthcare report cards provide information to consumers but do not represent a constraint on the behavior of healthcare providers. This is not the case with the report cards utilized in kidney transplantation. These report cards became more salient and binding, with additional oversight, in 2007 under the Centers for Medicare and Medicaid Services Conditions of Participation. This research investigates whether the additional oversight based on report card outcomes influences patient selection via waiting-list registrations at transplant centers that meet regulatory standards. Using data from a national registry of kidney transplant candidates from 2003 through 2010, we apply a before-and-after estimation strategy that isolates the impact of a binding report card. A sorting equilibrium model is employed to account for center-level heterogeneity and the presence of congestion/agglomeration effects and the results are compared to a conditional logit specification. Our results indicate that patient waiting-list registrations change in response to the quality information similarly on average if there is additional regulation or not. We also find evidence of congestion effects when spatial choice sets are smaller: new patient registrations are less likely to occur at a center with a long waiting list when fewer options are available.
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Affiliation(s)
- Mariétou H. Ouayogodé
- School of Medicine and Public Health, Department of Population Health Sciences, University of Wisconsin-Madison, 610 Walnut St, Madison, WI 53726 USA
| | - Kurt E. Schnier
- School of Social Sciences, Humanities and Arts, University of California, Merced, 5200 North Lake Road, Merced, CA 95343 USA
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Prang KH, Maritz R, Sabanovic H, Dunt D, Kelaher M. Mechanisms and impact of public reporting on physicians and hospitals' performance: A systematic review (2000-2020). PLoS One 2021; 16:e0247297. [PMID: 33626055 PMCID: PMC7904172 DOI: 10.1371/journal.pone.0247297] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 02/04/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Public performance reporting (PPR) of physician and hospital data aims to improve health outcomes by promoting quality improvement and informing consumer choice. However, previous studies have demonstrated inconsistent effects of PPR, potentially due to the various PPR characteristics examined. The aim of this study was to undertake a systematic review of the impact and mechanisms (selection and change), by which PPR exerts its influence. METHODS Studies published between 2000 and 2020 were retrieved from five databases and eight reviews. Data extraction, quality assessment and synthesis were conducted. Studies were categorised into: user and provider responses to PPR and impact of PPR on quality of care. RESULTS Forty-five studies were identified: 24 on user and provider responses to PPR, 14 on impact of PPR on quality of care, and seven on both. Most of the studies reported positive effects of PPR on the selection of providers by patients, purchasers and providers, quality improvement activities in primary care clinics and hospitals, clinical outcomes and patient experiences. CONCLUSIONS The findings provide moderate level of evidence to support the role of PPR in stimulating quality improvement activities, informing consumer choice and improving clinical outcomes. There was some evidence to demonstrate a relationship between PPR and patient experience. The effects of PPR varied across clinical areas which may be related to the type of indicators, level of data reported and the mode of dissemination. It is important to ensure that the design and implementation of PPR considered the perspectives of different users and the health system in which PPR operates in. There is a need to account for factors such as the structural characteristics and culture of the hospitals that could influence the uptake of PPR.
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Affiliation(s)
- Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Roxanne Maritz
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
- Rehabilitation Services and Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Hana Sabanovic
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
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Explaining health system responses to public reporting of cardiac surgery mortality in England and the USA. HEALTH ECONOMICS POLICY AND LAW 2021; 16:183-200. [PMID: 33455616 DOI: 10.1017/s1744133120000444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Public reporting of clinical performance is increasingly used in many countries to improve quality and enhance accountability of the health system. The assumption is that greater transparency will stimulate improvements by clinicians in response to peer pressure, patient choice or competition. The international diffusion of public reporting might suggest greater similarity between health systems. Alternatively, national and local contexts (including health system imperatives, professional power and organisational culture) might continue to shape its form and impact, implying continued divergence. The paper considers public reporting in the USA and England through the lens of Scott's 'pillars' institutional framework. The USA was arguably the first country to adopt public reporting systematically in the late 1980s. England is a more recent adopter; it is now being widely adopted through the National Health Service (NHS). Drawing on qualitative data from California and England, this paper compares the behavioural and policy responses to public reporting by health system stakeholders at micro, meso and macro levels and through the intersection of ideas, interests, institutions and individuals through. The interplay between the regulative, normative and cultural-cognitive pillars helps explain the observed patterns of on-going divergence.
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Martins M, Portela MC, Noronha MFD. [Health services research: historical, conceptual, and empirical highlights]. CAD SAUDE PUBLICA 2020; 36:e00006720. [PMID: 32901661 DOI: 10.1590/0102-311x00006720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/12/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mônica Martins
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Slater M, Abelson J, Wong ST, Langton JM, Burge F, Hogg W, Hogel M, Martin-Misener R, Johnston S. Priority measures for publicly reporting primary care performance: Results of public engagement through deliberative dialogues in 3 Canadian provinces. Health Expect 2020; 23:1213-1223. [PMID: 32744413 PMCID: PMC7696126 DOI: 10.1111/hex.13100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/09/2020] [Accepted: 06/19/2020] [Indexed: 11/30/2022] Open
Abstract
Objective While public reporting of hospital‐based performance measurement is commonplace, it has lagged in the primary care sector, especially in Canada. Despite the increasing recognition of patients as active partners in the health‐care system, little is known about what information about primary care performance is relevant to the Canadian public. We explored patient perspectives and priorities for the public reporting of primary care performance measures. Methods We conducted six deliberative dialogue sessions across three Canadian provinces (British Columbia, Ontario, Nova Scotia). Participants were asked to rank and discuss the importance of collecting and reporting on specific dimensions and indicators of primary care performance. We conducted a thematic analysis of the data. Results Fifty‐six patients participated in the dialogue sessions. Measures of access to primary care providers, communication with providers and continuity of information across all providers involved in a patient's care were identified as the highest priority indicators of primary care performance from a patient perspective. Several common measures of quality of care, such as rates of cancer screening, were viewed as too patient dependent to be used to evaluate the health system or primary care provider's performance. Conclusions Our findings suggest that public reporting aimed at patient audiences should focus on a nuanced measure of access, incorporation of context reported alongside measurement that is for public audiences, clear reporting on provider communication and a measure of information continuity. Participants highlighted the importance the public places on their providers staying up to date with advances in care.
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Affiliation(s)
- Morgan Slater
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Julia Abelson
- Department of Clinical Epidemiology & Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada.,School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Julia M Langton
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - William Hogg
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,CT Lamont Primary Health Care Research Centre, ÉlisabethBruyère Research Institute, Ottawa, ON, Canada
| | - Matthew Hogel
- CT Lamont Primary Health Care Research Centre, ÉlisabethBruyère Research Institute, Ottawa, ON, Canada
| | | | - Sharon Johnston
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,CT Lamont Primary Health Care Research Centre, ÉlisabethBruyère Research Institute, Ottawa, ON, Canada
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De Rosis S, Cerasuolo D, Nuti S. Using patient-reported measures to drive change in healthcare: the experience of the digital, continuous and systematic PREMs observatory in Italy. BMC Health Serv Res 2020; 20:315. [PMID: 32299440 PMCID: PMC7161006 DOI: 10.1186/s12913-020-05099-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/10/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The use of Patient Reported Experience Measures (PREMs) has great potential in healthcare service improvement, but a limited use. This paper presents an empirical case of PREMs innovation in Italy, to foster patient data use up to the ward level, by keeping strengths and addressing weaknesses of previous PREMs survey experiences. The paper reports key lessons learned in this ongoing experience of action research, directly involving practitioners. METHODS The aim of this paper is to present the results of an ongoing action research, encompassing the innovation of PREMs collection, reporting and use, currently adopted by 21 hospitals of two Italian regions. The continuous and systematic PREMs collection has been implemented between 2017 and 2019 and includes: a continuous web-based administration, using web-services; an augmented and positive questionnaire matching standard closed-ended questions with narrative sections; the inclusion and benchmarking of patient data within a shared performance evaluation system; public disclosure of aggregated anonymized data; a multi-level and real-time web-platform for reporting PREMs to professionals. The action research was carried out with practitioners in a real-life and complex context. The authors used multiple data sources and methods: observations, feedback of practitioners, collected during several workshops and meetings, and analysis of preliminary data on the survey implementation. RESULTS A continuous and systematic PREMs observatory was developed and adopted in two Italian regions. PREMs participation and response rates tend to increase over time, reaching stable percentages after the first months. Narrative feedback provide a 'positive narration' of episodes and behaviours that made the difference to patients and can inform quality improvement actions. Real-time reporting of quantitative and qualitative data is enabling a gratifying process of service improvement and people management at all the hospitals' levels. CONCLUSIONS The PREMs presented in this paper has been recognized by healthcare professionals and managers as a strategic and positive tool for improving an actual use of PREMs at system and ward levels, by measuring and highlighting positive deviances, such as compassionate behaviours.
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Affiliation(s)
- Sabina De Rosis
- Management and Healthcare Laboratory (MeS), Institute of Management and EMbeDS, Scuola Superiore Sant'Anna, piazza Martiri della Libertà 33, Pisa, Italy.
| | - Domenico Cerasuolo
- Management and Healthcare Laboratory (MeS), Institute of Management and EMbeDS, Scuola Superiore Sant'Anna, piazza Martiri della Libertà 33, Pisa, Italy
| | - Sabina Nuti
- Management and Healthcare Laboratory (MeS), Institute of Management and EMbeDS, Scuola Superiore Sant'Anna, piazza Martiri della Libertà 33, Pisa, Italy
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Mashouri P, Taati B, Quirt H, Iaboni A. Quality Indicators as Predictors of Future Inspection Performance in Ontario Nursing Homes. J Am Med Dir Assoc 2019; 21:793-798.e1. [PMID: 31676326 DOI: 10.1016/j.jamda.2019.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES There are several mechanisms for monitoring the quality of care in long-term care (LTC), including the use of quality indicators derived from resident assessments and formal inspections. The LTC inspection process is time and resource-intensive, and there may be opportunities to better target inspections. In this study, we aimed to examine whether quality indicators could predict future inspection performance in LTC homes across Ontario, Canada. SETTING AND PARTICIPANTS In total, 594 LTC homes across Ontario. METHODS Using a database compiling detailed inspection reports for the period from 2017 to 2018, we classified each home into 1 of 3 categories (in good standing, needing improvement, needing significant improvement). Machine learning techniques were used to examine whether publicly available Resident Assessment Instrument‒Minimum Data Set quality indicators for the period 2016‒2017 could predict facility classification based on inspection results. RESULTS After running a wide range of models, only a weak relationship was found between quality indicators and future inspection performance. The best-performing model was able to achieve a classification accuracy of 40.1%. Feature analysis was performed on the final model to identify which quality indicators were most indicative of predicted poor performance. Experiencing worsened pain, restraint use, and worsened pressure ulcers were correlated with homes predicted as needing significant improvement. Counterintuitively, improved physical functioning had an inverse relationship with homes predicted as being in good standing. CONCLUSIONS AND IMPLICATIONS Most quality indicators are poor predictors of inspection performance. Further work is required to explore the limited relationship between these 2 measures of LTC quality, and to identify other quality measures that may be useful as predictors of facilities facing difficulty in meeting quality standards.
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Affiliation(s)
- Pouria Mashouri
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Babak Taati
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Computer Science, University of Toronto, Toronto, Ontario, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada
| | - Hannah Quirt
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrea Iaboni
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Center for Mental Health, University Health Network, Toronto, Ontario, Canada.
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Akinleye DD, McNutt LA, Lazariu V, McLaughlin CC. Correlation between hospital finances and quality and safety of patient care. PLoS One 2019; 14:e0219124. [PMID: 31419227 PMCID: PMC6697357 DOI: 10.1371/journal.pone.0219124] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 06/17/2019] [Indexed: 11/19/2022] Open
Abstract
Background Hospitals under financial pressure may struggle to maintain quality and patient safety and have worse patient outcomes relative to well-resourced hospitals. Poor predictive validity may explain why previous studies on the association between finances and quality/safety have been equivocal. This manuscript employs principal component analysis to produce robust measures of both financial status and quality/safety of care, to assess our a priori hypothesis: hospital financial performance is associated with the provision of quality care, as measured by quality and safety processes, patient outcomes, and patient centered care. Methods This 2014 cross-sectional study investigated hospital financial condition and hospital quality and safety at acute care hospitals. The hospital financial data from the Centers for Medicare and Medicaid Services (CMS) cost report were used to develop a composite financial performance score using principal component analysis. Hospital quality and patient safety were measured with a composite quality/safety performance score derived from principal component analysis, utilizing a range of established quality and safety indicators including: risk-standardized inpatient mortality, 30-day mortality, 30-day readmissions for select conditions, patient safety indicators from inpatient admissions, process of care chart reviews, CMS value-based purchasing total performance score and patient experience of care surveys. The correlation between the composite financial performance score and the composite quality/safety performance score was calculated using linear regression adjusting for hospital characteristics. Results Among the 108 New York State acute care facilities for which data were available, there is a clear relationship between hospital financial performance and hospital quality/safety performance score (standardized correlation coefficient 0.34, p<0.001). The composite financial performance score is also positively associated with the CMS Value Based Purchasing Total Performance Score (standardized correlation coefficient 0.277, p = 0.002); while it is negatively associated with 30 day readmission for all outcomes (standardized correlation coefficient -0.236, p = 0.013), 30-day readmission for congestive heart failure (standardized correlation coefficient -0.23, p = 0.018), 30 day readmission for pneumonia (standardized correlation coefficient -0.209, p = 0.033), and a decrease in 30-day mortality for acute myocardial infarction (standardized correlation coefficient -0.211, p = 0.027). Used alone, operating margin and total margin are poor predictors of quality and safety outcomes. Conclusions Strong financial performance is associated with improved patient reported experience of care, the strongest component distinguishing quality and safety. These findings suggest that financially stable hospitals are better able to maintain highly reliable systems and provide ongoing resources for quality improvement.
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Affiliation(s)
- Dean D Akinleye
- School of Public Health, State University of New York, University at Albany, Albany, NY, United States of America
| | - Louise-Anne McNutt
- Institute for Health and the Environment, State University of New York, University at Albany, Albany, NY, United States of America
| | - Victoria Lazariu
- School of Public Health, State University of New York, University at Albany, Albany, NY, United States of America
| | - Colleen C McLaughlin
- Albany College of Pharmacy and Health Sciences, Albany, NY, United States of America
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de Cordova PB, Rogowski J, Riman KA, McHugh MD. Effects of Public Reporting Legislation of Nurse Staffing: A Trend Analysis. Policy Polit Nurs Pract 2019; 20:92-104. [PMID: 30922205 PMCID: PMC6813777 DOI: 10.1177/1527154419832112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Public reporting is a tactic that hospitals and other health care facilities use to provide data such as outcomes to clinicians, patients, and payers. Although inadequate registered nurse (RN) staffing has been linked to poor patient outcomes, only eight states in the United States publicly report staffing ratios-five mandated by legislation and the other three electively. We examine nurse staffing trends after the New Jersey (NJ) legislature and governor enacted P.L.1971, c.136 (C.26:2 H-13) on January 24, 2005, mandating that all health care facilities compile, post, and report staffing information. We conduct a secondary analysis of reported data from the State of NJ Department of Health on 73 hospitals in 2008 to 2009 and 72 hospitals in 2010 to 2015. The first aim was to determine if NJ hospitals complied with legislation, and the second was to identify staffing trends postlegislation. On the reports, staffing was operationalized as the number of patients per RN per quarters. We obtained 30 quarterly reports for 2008 through 2015 and cross-checked these reports for data accuracy on the NJ Department of Health website. From these data, we created a longitudinal data set of 13 inpatient units for each hospital (14,158 observations) and merged these data with American Hospital Association Annual Survey data. The number of patients per RN decreased for 10 specialties, and the American Hospital Association data demonstrate a similar trend. Although the number of patients does not account for patient acuity, the decrease in the patients per RN over 7 years indicated the importance of public reporting in improving patient safety.
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Affiliation(s)
- Pamela B. de Cordova
- Rutgers, the State University School of Nursing, Faculty Researcher for the New Jersey Collaborating Center, Newark, NJ, USA
| | - Jeannette Rogowski
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
| | - Kathryn A. Riman
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Matthew D. McHugh
- Nursing Education, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Factors Associated With Hospices' Nonparticipation in Medicare's Hospice Compare Public Reporting Program. Med Care 2018; 57:28-35. [PMID: 30489545 DOI: 10.1097/mlr.0000000000001016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To enhance the quality of hospice care and to facilitate consumers' choices, the Centers for Medicare and Medicaid Services (CMS) began the Hospice Quality Reporting Program, in which CMS posted the quality measures of participating hospices on its reporting website, Hospice Compare. Little is known about the participation rate and the types of nonparticipating hospices. OBJECTIVE To examine the factors associated with hospices' nonparticipation in Hospice Compare. RESEARCH DESIGN We analyzed data from the CMS 2016 Hospice Compare. "Nonparticipants" were those who did not submit any quality measure. With the data of the Provider of Service file, the Healthcare Cost Report Information System, and the Area Health Resources File, multivariate logistic regressions estimated the association between nonparticipants and hospice and market characteristics, including ownership, size, nurse staffing ratio, and market competition intensity. RESULTS Among the 4123 certified hospices subject to penalty from nonparticipation, 259 did not participate in Hospice Compare. California, New Mexico, Texas, and Wyoming had participation rates lower than 80%. Hospices that were for-profit, had no accreditation, had few nurses per patient day, provided no inpatient care, and were located in competitive markets were less likely to participate than other hospices. CONCLUSIONS Hospice Compare successfully motivated hospice in participating in the quality report program in most of states. For-profit hospices, hospices with less quality, and hospices located in competitive markets were less likely to participate. Further research is warranted to examine the quality of these nonparticipants, especially in the 4 states with a lower participation rate.
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Prang KH, Canaway R, Bismark M, Dunt D, Miller JA, Kelaher M. Public performance reporting and hospital choice: a cross-sectional study of patients undergoing cancer surgery in the Australian private healthcare sector. BMJ Open 2018; 8:e020644. [PMID: 29703855 PMCID: PMC5922515 DOI: 10.1136/bmjopen-2017-020644] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES National mandatory public performance reporting (PPR) for Australian public hospitals, including measures of cancer surgery waiting times, was introduced in 2011. PPR is voluntary for private hospitals. The aims of this study were to assess whether PPR of hospital data is used by patients with breast, bowel or lung cancer when selecting a hospital for elective surgery and how PPR could be improved to meet their information needs. DESIGN A national cross-sectional postal questionnaire. SETTING Australian private healthcare sector. PARTICIPANTS Private patients with breast, bowel or lung cancer who attended a public or private hospital for elective surgery (n=243) in 2016. OUTCOME MEASURES Patients' choice of hospital, use of PPR information and preferred areas of PPR information. Descriptive and conventional qualitative content analyses were conducted. RESULTS Two hundred and twenty-eight respondents (94%) attended a private hospital. Almost half could choose a hospital. Choice of hospital was not influenced by PPR data (92% unaware) but by their specialist (90%). Respondents considered PPR to be important (71%) but they did not want to see the information, preferring their general practitioners (GPs) to tell them about it (40%). Respondents considered surgery costs (59%), complications (58%) and recovery success rates (57%) to be important areas of information that should be publicly reported. Almost half suggested that quality indicators should be reported at the individual clinician level. Analysis of the open-ended questions identified four themes: (1) decision-making factors; (2) data credibility; (3) unmet information needs and (4) unintended consequences. CONCLUSIONS PPR of hospital data had no substantial impact on patients' choice of hospital. Nonetheless, many respondents expressed interest in using it in future. To increase PPR awareness and usability, personalised and integrated information on cost and quality of hospitals is required. Dissemination of PPR information via specialists and GPs could assist patients to interpret the data and support decision-making.
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Affiliation(s)
- Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julie A. Miller
- Endocrine Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Canaway R, Bismark M, Dunt D, Prang KH, Kelaher M. "What is meant by public?": Stakeholder views on strengthening impacts of public reporting of hospital performance data. Soc Sci Med 2018. [PMID: 29524870 DOI: 10.1016/j.socscimed.2018.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Public reporting of hospital performance data is a developing area that is gaining increased attention. This is the first study to explore a range of stakeholder opinions on how such public reporting could be strengthened in Australia. Thirty-four semi-structured interviews were conducted with a purposive sample of expert healthcare consumer, provider and purchaser informants who worked in a variety of senior roles and had knowledge of or involvement in public reporting of hospital data within the public or private healthcare sectors. Informants from all Australian states, territory and national jurisdictions participated. Thematic analysis was used to gain an overview of experts' opinions to inform policy and systems-development for strengthening foundational frameworks for public reporting of health services performance. Themes arising were synthesised to generate explanatory figures to highlight key areas for strengthening public reporting. Our findings suggest that in Australia there is a lack of agreement on what the objectives and who the audience are for public reporting of hospital performance data. Without this shared understanding it is difficult to strengthen frameworks and impacts of public reporting. When developing frameworks for public reporting of hospital data in Australia, more explicit definition of what or who are the 'public' is needed along with identification of barriers, desired impacts, data needs, and data collection/reporting/feedback mechanisms. All relevant stakeholders should be involved in design of public reporting frameworks. Offering multiple systems of public reporting, each tailored to particular audiences, might enable greater impact of reporting towards improved hospital quality and safety, and consumer knowledge to inform treatment decisions. This study provides an overview of perspectives, but further research is warranted to develop PR frameworks that can generate greatest impacts for the needs of various audiences.
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Affiliation(s)
- Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, The University of Melbourne, 3010, Victoria, Australia.
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, The University of Melbourne, 3010, Victoria, Australia.
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, The University of Melbourne, 3010, Victoria, Australia.
| | - Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, The University of Melbourne, 3010, Victoria, Australia.
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, The University of Melbourne, 3010, Victoria, Australia.
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Prang KH, Canaway R, Bismark M, Dunt D, Kelaher M. The use of public performance reporting by general practitioners: a study of perceptions and referral behaviours. BMC FAMILY PRACTICE 2018; 19:29. [PMID: 29433449 PMCID: PMC5810107 DOI: 10.1186/s12875-018-0719-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 01/29/2018] [Indexed: 11/14/2022]
Abstract
Background Public performance reporting (PPR) of hospital data aims to improve quality of care in hospitals and to inform consumer choice. In Australia, general practitioners (GPs) are gatekeepers to secondary care with patients requiring their referral for non-emergency access. Despite their intermediary role, GPs have been generally overlooked as potential users of PPR of hospital data, with the majority of the PPR research focussing on consumers, surgeons and hospitals. Methods We examined the use of PPR of hospital data by GPs when referring patients to hospitals. Semi-structured interviews were conducted with 40 GPs, recruited via the Victorian Primary Care Practice-Based Research Network and GP teaching practices in Victoria, Australia. The interviews were recorded, transcribed and analysed thematically. Results We found that the majority of GPs did not use PPR when referring patients to hospitals. Instead, they relied mostly on informal sources of information such as their own or patients’ previous experiences. Barriers that prevented GPs’ use of PPR in their decision making included: lack of awareness and accessibility; perceived lack of data credibility; restrictive geographical catchments for certain hospitals; limited choices of public hospitals in regional and rural areas; and no mandatory PPR for private hospitals. Conclusions Our findings suggest that lack of PPR awareness prevented GPs from using it in their referral practice. As gatekeepers to secondary care, GPs are in a position to guide patients in their treatment decisions and referrals using available PPR data. We suggest that there needs to be greater involvement by GPs in the development of hospital performance and quality indicators in Australia if GPs are to make greater use of them. The indicators require further development before GPs perceive them as valid, credible, and of use for informing their referral practices. Electronic supplementary material The online version of this article (10.1186/s12875-018-0719-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia.
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Senier L, Lee R, Nicoll L. The strategic defense of physician autonomy: State public health agencies as countervailing powers. Soc Sci Med 2017; 186:113-121. [PMID: 28622609 PMCID: PMC5531602 DOI: 10.1016/j.socscimed.2017.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
Advances in genetic testing and the aggressive marketing of genetic tests by commercial diagnostic laboratories have driven both consumer demand and the need for unbiased information about how tests should guide healthcare delivery. This paper uses the countervailing powers framework to explore the role of state public health agencies as arbiters of quality and safety, specifically through their efforts to encourage physicians to follow evidence-based recommendations for screening for hereditary cancers. Social scientists have often viewed actions by the state to regulate cost, quality, or safety as a threat to physician autonomy. This paper draws on case studies from two US states-Michigan and Connecticut-to better understand the specific role of state public health agencies, and especially whether their activities to encourage adherence to evidence-based recommendations bolster or subvert the interests of other parties in the healthcare arena. We find that lacking authority to compel provider to follow evidence-based recommendations, they improvised ways to foster compliance voluntarily, for example, by emphasizing the role of the physician as gatekeeper, thus affirming the importance of physician autonomy and clinical judgment. Both states also used public health surveillance data to make rare diseases visible and illustrate gaps between recommendations and practice. Finally, they both showed that following evidence-based recommendations could align the professional and market interests of healthcare stakeholders. Both states employed similar strategies with similar effects, despite substantial differences in the regulatory climate and organizational capacity. Taken as a whole, their activities orchestrated a countervailing response that checked the profit-seeking motives of commercial laboratories. Our findings demonstrate that rather than eroding physician autonomy, state action to monitor healthcare quality and encourage adherence to evidence-based recommendations can actually reinforce physician authority.
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Affiliation(s)
- Laura Senier
- Department of Sociology & Anthropology, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States; Department of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States.
| | - Rachael Lee
- Department of Sociology & Anthropology, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States
| | - Lauren Nicoll
- Department of Sociology & Anthropology, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States
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Canaway R, Bismark M, Dunt D, Kelaher M. Perceived barriers to effective implementation of public reporting of hospital performance data in Australia: a qualitative study. BMC Health Serv Res 2017; 17:391. [PMID: 28592277 PMCID: PMC5463349 DOI: 10.1186/s12913-017-2336-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 05/25/2017] [Indexed: 05/29/2023] Open
Abstract
Background Public reporting of government funded (public) hospital performance data was mandated in Australia in 2011. Studies suggest some benefit associated with such public reporting, but also considerable scope to improve reporting systems. Methods In 2015, a purposive sample of 41 expert informants were interviewed, representing consumer, provider and purchasers perspectives across Australia’s public and private health sectors, to ascertain expert opinion on the utility and impact of public reporting of health service performance. Qualitative data was thematically analysed with a focus on reporting perceived strengths and barriers to public reporting of hospital performance data (PR). Results Many more weaknesses and barriers to PR were identified than strengths. Barriers were: conceptual (unclear objective, audience and reporting framework); systems-level (including lack of consumer choice, lack of consumer and clinician involvement, jurisdictional barriers, lack of mandate for private sector reporting); technical and resource related (including data complexity, lack of data relevance consistency, rigour); and socio-cultural (including provider resistance to public reporting, poor consumer health literacy, lack of consumer empowerment). Conclusions Perceptions of the Australian experience of PR highlight important issues in its implementation that can provide lessons for Australia and elsewhere. A considerable weakness of PR in Australia is that the public are often not considered its major audience, resulting in information ineffectually framed to meet the objective of PR informing consumer decision-making about treatment options. Greater alignment is needed between the primary objective of PR, its audience and audience needs; more than one system of PR might be necessary to meet different audience needs and objectives. Further research is required to assess objectively the potency of the barriers to PR suggested by our panel of informants. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2336-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Melbourne, VIC, 3010, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Melbourne, VIC, 3010, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Melbourne, VIC, 3010, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Melbourne, VIC, 3010, Australia.
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Liu C, Tang Y, Wang D, Zhang X. The effect of public reporting presentation on patients' decision making: An experimental survey in Yunan Province, China. Medicine (Baltimore) 2017; 96:e7203. [PMID: 28614266 PMCID: PMC5478351 DOI: 10.1097/md.0000000000007203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 04/28/2017] [Accepted: 05/18/2017] [Indexed: 12/04/2022] Open
Abstract
Public reporting of comparative performance information (PRCPI) influence patients' decision making and optimal presentation of PRCPI is urgently required for successful patients' engagement and quality improvement. This study was to explore the presentation of PRCPI impacting on consumers' decision making.This research applied a controlled design, with participants allocated randomly to 6 groups, and a total of 515 participants were recruited in Yunnan province. Five aspects of PRCPI presentations were evaluated, including display (star rating vs numeric information), and whether information was simplified, interpreted, overload, or ranked. Participants were stimulated to identify the best or worst physicians with a hypothetical scenario. Main outcome measures were correct choices rate of best/worst physicians, indicating participants fully understood and correctly used PRCPI. χ test and logistic regression were applied to assess the effect between different presentations on consumers' decision making.The correct choices rate is only 48.93%. Compared with star rating, numerical information helped participants differentiate low-performance physicians (OR = 2.573, P = .029), including low-performance physicians in antibiotics (OR = 2.974, P = .031) and low-performance physicians in injections (OR = 2.369, P = .035). Disordered information impeded participants to fully understand and correctly use PRCPI (OR = 0.519, P = .041). The effect was mainly reflected on participants differentiating low-performance physicians (OR = 0.491, P = .039) and low-performance physicians in injections (OR = 0.440, P = .016). Other aspects of PRCPI showed nonsignificant impacts on consumers' decision making.Presentation, including information display and ranking, can influence patients' correct usage of PRCPI and the effect was mainly observed when the patients were identifying poorly performing physicians. The present study demonstrated that numerical and ranked PRCPI, combined with sufficient patient education, could be most effective to facilitate patient use.
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Blake RS, Clarke HD. Hospital Compare and Hospital Choice: Public Reporting and Hospital Choice by Hip Replacement Patients in Texas. Med Care Res Rev 2017; 76:184-207. [DOI: 10.1177/1077558717699311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Centers for Medicare & Medicaid Services publicizes comparative performance data on Hospital Compare, a website maintained to support consumer decision making. Given the agency’s goal, this study investigates the relationship between public reporting and hospital choices of hip replacement patients in Texas. Estimating individual-level valuations of provider characteristics allowing for heterogeneity across patients, we find consumer selections and hospitals’ displayed performance vary together in time. Comparing associations involving public reporting with those associated with more readily observable hospital attributes, we conclude relationships coinciding with release of comparative performance data are modest, but not inconsequential. Our use of an empirical strategy novel for evaluation of public reporting has methodological implications, while the study’s affirmative result is of potential interest to policy makers and administrators.
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Smith MA, Bednarz L, Nordby PA, Fink J, Greenlee RT, Bolt D, Magnan EM. Increasing Consumer Engagement by Tailoring a Public Reporting Website on the Quality of Diabetes Care: A Qualitative Study. J Med Internet Res 2016; 18:e332. [PMID: 28003173 PMCID: PMC5214669 DOI: 10.2196/jmir.6555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/14/2016] [Accepted: 11/23/2016] [Indexed: 12/02/2022] Open
Abstract
Background The majority of health care utilization decisions in the United States are made by persons with multiple chronic conditions. Existing public reports of health system quality do not distinguish care for these persons and are often not used by the consumers they aim to reach. Objective Our goal was to determine if tailoring quality reports to persons with diabetes mellitus and co-occurring chronic conditions would increase user engagement with a website that publicly reports the quality of diabetes care. Methods We adapted an existing consumer-focused public reporting website using adult learning theory to display diabetes quality reports tailored to the user’s chronic condition profile. We conducted in-depth cognitive interviews with 20 individuals who either had diabetes and/or cared for someone with diabetes to assess the website. Interviews were audiotaped and transcribed, then analyzed using thematic content analysis. Results Three themes emerged that suggested increased engagement from tailoring the site to a user’s chronic conditions: ability to interact, relevance, and feeling empowered to act. Conclusions We conclude that tailoring can be used to improve public reporting sites for individuals with chronic conditions, ultimately allowing consumers to make more informed health care decisions.
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Affiliation(s)
- Maureen A Smith
- Health Innovation Program, School of Medicine and Public Health-Madison, University of Wisconsin, Madison, WI, United States.,Department of Population Health Sciences, School of Medicine and Public Health-Madison, University of Wisconsin, Madison, WI, United States.,Department of Family Medicine and Community Health, University of Wisconsin, School of Medicine and Public Health-Madison, Madison, WI, United States
| | - Lauren Bednarz
- Health Innovation Program, School of Medicine and Public Health-Madison, University of Wisconsin, Madison, WI, United States.,Department of Population Health Sciences, School of Medicine and Public Health-Madison, University of Wisconsin, Madison, WI, United States
| | - Peter A Nordby
- Health Innovation Program, School of Medicine and Public Health-Madison, University of Wisconsin, Madison, WI, United States.,Department of Population Health Sciences, School of Medicine and Public Health-Madison, University of Wisconsin, Madison, WI, United States
| | - Jennifer Fink
- Department of Health Informatics, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, United States.,Aurora Research Institute, Aurora Health Care, Milwaukee, WI, United States
| | - Robert T Greenlee
- Center for Clinical Epidemiology, Marshfield Clinic Research Foundation, Marshfield, WI, United States
| | - Daniel Bolt
- Department of Educational Psychology, University of Wisconsin-Madison, Madison, WI, United States
| | - Elizabeth M Magnan
- Department of Family and Community Medicine, University of California, Davis, Sacramento, CA, United States
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Du X, Zhang X, Tang Y. General practitioners' perceptions of public reporting of institution and individual medicine prescribing data. BMC Health Serv Res 2016; 16:641. [PMID: 27829429 PMCID: PMC5103380 DOI: 10.1186/s12913-016-1893-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public reporting of institution- and individual-level performance data has recently become a popular topic in the health care field. This study (1) evaluated the perceptions of general practitioners on the public reporting of institutional and individual medicine prescribing data in primary care institutions, and (2) compared the difference among the perceptions of general practitioners on the dimensions of necessity, methodological rigor, and impact of public reporting medicine prescribing data. METHODS We conducted a survey in 10 primary care institutions in Q city, Hubei province. General practitioners who hold prescribing license were eligible for this study; we surveyed all eligible general practitioners in July 2014. The survey instrument was developed based on previous studies and expert opinions. Paired t-test or nonparametric test was used to evaluate the difference in perceptions between the institutional and individual medicine prescribing data reporting. An analysis of variance test was used to analyze the score differences among the three dimensions (i.e., necessity, methodological rigor, and impact). RESULTS A total of 154 general practitioners were surveyed in this study. No significant difference in the perceptions of general practitioners was observed between the institution- and individual-level medicine prescribing data reporting (p > 0.05). General practitioners have significantly different perceptions on the three dimensions of the institution- and individual-level data reporting (p < 0.05). Methodological rigor obtained the lowest score. Regarding the strategies to facilitate the medicine prescribing data reporting, over 80 % of general practitioners selected the items that disclose process measures and not outcome measures, as well as educate patients on data interpretation. CONCLUSION The perceptions of general practitioners between institution- and individual-level data reporting have no significant difference. General practitioners place their utmost concern on public reporting on the methodological rigor. Processing measures and patient education to improve the efficiency of public reporting require substantial attention.
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Affiliation(s)
- Xin Du
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13. Hangkong Road, Wuhan, 430030, Hubei province, People's Republic of China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13. Hangkong Road, Wuhan, 430030, Hubei province, People's Republic of China.
| | - Yuqing Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13. Hangkong Road, Wuhan, 430030, Hubei province, People's Republic of China
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Mannion R, Davies H, Marshall M. Impact of star performance ratings in English acute hospital trusts. J Health Serv Res Policy 2016; 10:18-24. [PMID: 15667700 DOI: 10.1177/135581960501000106] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To explore some of the impacts of star performance ratings in acute hospital trusts in England. Methods A multiple case study design was used which incorporated purposeful sampling of ‘low’ and ‘high’ performing trusts using the star rating system. In each case study site, data collection comprised semi-structured interviews and documentary analysis. Between eight and 12 senior managers and senior clinicians were interviewed in each organisation. Results There was a general view that the star ratings as presently constituted did not represent a rounded or balanced scorecard of their own organisation's performance and a widespread belief that the information used to calculate the ratings was often incomplete and inaccurate. The star ratings were viewed by some managers as useful, in that they gave added weight to their trust's modernisation agenda. In addition to driving beneficial change, the ratings were also sometimes reported to have inadvertently induced a range of unintended and dysfunctional consequences, including tunnel vision and a distortion of clinical priorities, bullying and intimidation, erosion of public trust and reduced staff morale, and ghettoisation. Conclusions Set in the context of an international body of research, this study highlights some important gaps in knowledge and failings in current policy and practice. In particular, the many dysfunctional consequences of publishing star ratings indicate a need for a re-examination of performance management policies.
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Affiliation(s)
- Russell Mannion
- Centre for Health Economics, University of York, York YO10 5DD, UK
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Waelli M, Gomez ML, Sicotte C, Zicari A, Bonnefond JY, Lorino P, Minvielle E. Keys to successful implementation of a French national quality indicator in health care organizations: a qualitative study. BMC Health Serv Res 2016; 16:553. [PMID: 27716193 PMCID: PMC5053143 DOI: 10.1186/s12913-016-1794-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 09/24/2016] [Indexed: 12/30/2022] Open
Abstract
Background Several countries have launched public reporting systems based on quality indicators (QIs) to increase transparency and improve quality in health care organizations (HCOs). However, a prerequisite to quality improvement is successful local QI implementation. The aim of this study was to explore the pathway through which a mandatory QI of the French national public reporting system, namely the quality of the anesthesia file (QAF), was put into practice. Method Seven ethnographic case studies in French HCOs combining in situ observations and 37 semi-structured interviews. Results A significant proportion of potential QAF users, such as anesthetists or other health professionals were often unaware of quality data. They were, however, involved in improvement actions to meet the QAF criteria. In fact, three intertwined factors influenced QAF appropriation by anesthesia teams and impacted practice. The first factor was the action of clinical managers (chief anesthetists and head of department) who helped translate public policy into local practice largely by providing legitimacy by highlighting the scientific evidence underlying QAF, achieving consensus among team members, and pointing out the value of QAF as a means of work recognition. The two other factors related to the socio-material context, namely the coherence of information systems and the quality of interpersonal ties within the department. Conclusions Public policy tends to focus on the metrological validity of QIs and on ranking methods and overlooks QI implementation. However, effective QI implementation depends on local managerial activity that is often invisible, in interaction with socio-material factors. When developing national quality improvement programs, health authorities might do well to specifically target these clinical managers who act as invaluable mediators. Their key role should be acknowledged and they ought to be provided with adequate resources.
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Affiliation(s)
- Mathias Waelli
- EA 7438 MOS, EHESP (French School of Public Health), Rennes, France. .,EHESP, 8 rue Maria Helena Vieira Da Silva - 75014, Paris, France.
| | | | - Claude Sicotte
- EA 7438 MOS, EHESP (French School of Public Health), Rennes, France.,Montreal University, Montreal, Canada
| | | | | | | | - Etienne Minvielle
- EA 7438 MOS, EHESP (French School of Public Health), Rennes, France.,Gustave Roussy Institute, Villejuif, France
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Mechanisms and effects of public reporting of surgeon outcomes: A systematic review of the literature. Health Policy 2016; 120:1151-1161. [DOI: 10.1016/j.healthpol.2016.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 11/21/2022]
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Nguyen OK, Halm EA, Makam AN. Relationship between hospital financial performance and publicly reported outcomes. J Hosp Med 2016; 11:481-8. [PMID: 26929094 PMCID: PMC5362822 DOI: 10.1002/jhm.2570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/13/2016] [Accepted: 02/03/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hospitals that have robust financial performance may have improved publicly reported outcomes. OBJECTIVES To assess the relationship between hospital financial performance and publicly reported outcomes of care, and to assess whether improved outcome metrics affect subsequent hospital financial performance. DESIGN Observational cohort study. SETTING AND PATIENTS Hospital financial data from the Office of Statewide Health Planning and Development in California in 2008 and 2012 were linked to data from the Centers for Medicare and Medicaid Services Hospital Compare website. MEASUREMENTS Hospital financial performance was measured by net revenue by operations, operating margin, and total margin. Outcomes were 30-day risk-standardized mortality and readmission rates for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PNA). RESULTS Among 279 hospitals, there was no consistent relationship between measures of financial performance in 2008 and publicly reported outcomes from 2008 to 2011 for AMI and PNA. However, improved hospital financial performance (by any of the 3 measures) was associated with a modest increase in CHF mortality rates (ie, 0.26% increase in CHF mortality rate for every 10% increase in operating margin [95% confidence interval: 0.07%-0.45%]). Conversely, there were no significant associations between outcomes from 2008 to 2011 and subsequent financial performance in 2012 (P > 0.05 for all). CONCLUSIONS Robust financial performance is not associated with improved publicly reported outcomes for AMI, CHF, and PNA. Financial incentives in addition to public reporting, such as readmissions penalties, may help motivate hospitals with robust financial performance to further improve publicly reported outcomes. Reassuringly, improved mortality and readmission rates do not necessarily lead to loss of revenue. Journal of Hospital Medicine 2016;11:481-488. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Oanh Kieu Nguyen
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
- Address for correspondence and reprint requests: Oanh Kieu Nguyen, MD, 5323 Harry Hines Blvd., Dallas, Texas 75390-9169; Telephone: 214-648-3135; Fax: 214-648-3232;
| | - Ethan A. Halm
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Anil N. Makam
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
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Liu C, Zhang X, Wang X, Zhang X, Wan J, Zhong F. Does public reporting influence antibiotic and injection prescribing to all patients? A cluster-randomized matched-pair trial in china. Medicine (Baltimore) 2016; 95:e3965. [PMID: 27367995 PMCID: PMC4937909 DOI: 10.1097/md.0000000000003965] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The inappropriate use and overuse of antibiotics and injections are serious threats to global population, and the public reporting of health care performance (PRHCP) has been an important instrument for improving the quality of care. However, existing evidence shows a mixed effect of PRHCP. This study is to explore the potential effectiveness of PRHCP that contributes to the convincing evidence of health policy and reform.This study was undertaken in Qian Jiang City, applying a matched-pair cluster-randomized trial. Twenty primary care institutions were treated as clusters and were matched into 10 pairs. Clusters in each pair were randomly assigned into a control or an intervention group. Physicians' prescribing information was publicly reported to patients and physicians monthly in the intervention group from October 2013. A total of 748,632 outpatient prescriptions were included for difference-in-difference (DID) regression model and subgroups (SGs) analysis.Overall, PRHCP intervention led to a slight reduction in the use of combined antibiotics (odds ratio [OR] = 0.870, P < 0.001) and slowed the average expenditure increase of patients (coefficient = -0.051, P < 0.001). SG analysis showed the effect of PRHCP varied among patients with different characteristics. PRHCP decreased the probability of prescriptions requiring antibiotics, combined antibiotics, and injections of patients aged 18 to 64 years old (OR < 1), and all results were statistically significant. By contrast, the results of elderly and minor patients with health insurance showed that PRHCP increased their probability of prescriptions requiring antibiotics and injections. PRHCP slowed the increase of average expenditure of most SGs.PRHCP intervention can influence the prescribing pattern of physicians. Patient factors such as age and health insurance influence the effect of PRHCP intervention, which imply that PRHCP should be designed for different patients. Patient education, aiming at radically changing attitudes toward antibiotics and injections, should be taken to promote the effectiveness of public reporting in China.
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Affiliation(s)
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
- Correspondence: Xinping Zhang, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road No. 13, Wuhan, Hubei Province, China (e-mail: )
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Incentives in Rheumatology: the Potential Contribution of Physician Responses to Financial Incentives, Public Reporting, and Treatment Guidelines to Health Care Sustainability. Curr Rheumatol Rep 2016; 18:42. [PMID: 27240436 DOI: 10.1007/s11926-016-0596-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Concerns about the sustainability of current health care expenditure are focusing attention on the cost, quality and value of health care provision. Financial incentives, for example pay-for-performance (P4P), seek to reward quality and value in health care provision. There has long been an expectation that P4P schemes are coming to rheumatology. We review the available evidence about the use of incentives in this setting and provide two emerging examples of P4P schemes which may shape the future of service provision in rheumatology. Currently, there is limited and equivocal evidence in rheumatology about the impact of incentive schemes. However, reporting variation in the quality and provision of rheumatology services has highlighted examples of inefficiencies in the delivery of care. If financial incentives can improve the delivery of timely and appropriate care for rheumatology patients, then they may have an important role to play in the sustainability of health care provision.
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Du X, Zhang X, Tang Y, Zhang X, Wang L, Wang X. How public reporting of prescription quality indicators influence prescribing practices? A survey of general practitioners. J Eval Clin Pract 2015. [PMID: 26202749 DOI: 10.1111/jep.12410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Public reporting of performance data is one of the most popular topics in health care field. The aim of this study was to investigate the transparency mechanism, that is, how public reporting influenced general practitioners' (GPs) prescribing practices. METHOD GPs who had the license to prescribe medicine of all 10 primary care institutions were surveyed. Data were collected by an instrument, which exhibited satisfactory reliability and validity (Cronbach's alpha > 0.7; average variance extracted > 0.5; composite reliability > 0.7). Data analysis was conducted by structural equation model. RESULTS The results showed that GPs' perceived value (GP's overall assessment of the worth of the public reporting) and attitude (the psychological reaction to public reporting) had a significantly direct effect on behavioural intention (r = 0.28; r = 0.36), and were affected by information accessibility (r = 0.63; r = 0.32). Attitude had a significant effect on perceived value(r = 0.45). Perceived risk (the perceptions of the possible loss due to public reporting, e.g. decreasing their income) did not have a significant relationship with information accessibility, attitude and behavioural intention(r = -0.09; r = 0.01; r = -0.07). CONCLUSION The information accessibility, perceived value and attitude have strong effects on prescribing practices of GPs, whereas perceived risk did not play a role in influencing the prescribing practices. Policymakers need to improve the accessibility of prescription quality indicators and pay attention to the perceived values and attitudes of GPs. Policymakers also need to strengthen the risk education of GPs and attach incentives to transparent regulation.
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Affiliation(s)
- Xin Du
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yuqing Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiaopeng Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Lijun Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xuan Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Dietrich M, Renner S. Subjective Quality Information: Effects of Patient Experience Outcomes and Display Formats on Evaluation and Choice Intentions. Health Mark Q 2015; 32:234-49. [PMID: 26368299 DOI: 10.1080/07359683.2015.1061850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study analyzes the impact of subjective quality information in the form of aggregate patient experience outcomes on respondent evaluation and intended choice of hospitals. We compared clinical performance-based quality measures (i.e., wound infection rates) with participant evaluations and choice intentions when they were additionally provided with subjective quality information (i.e., patient experience outcomes in different display formats). Results suggest that patient experience outcomes significantly affected the evaluations and choice intentions. Additionally, we found significant effects of subjective information display formats. Limitations, directions for future research, and implications for publishing subjective quality information in health care markets are discussed.
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Affiliation(s)
- Martin Dietrich
- a Department of Law and Economics , Saarland University , Saarbrücken , Germany
| | - Simone Renner
- b Department of Economics and Behavioral Sciences , University of Freiburg , Freiburg , Germany
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37
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Liu C, Zhang X, Wan J. Public reporting influences antibiotic and injection prescription in primary care: a segmented regression analysis. J Eval Clin Pract 2015; 21:597-603. [PMID: 25902726 DOI: 10.1111/jep.12343] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Inappropriate use and overuse of antibiotics and injections are serious threats to the global population, particularly in developing countries. In recent decades, public reporting of health care performance (PRHCP) has been an instrument to improve the quality of care. However, existing evidence shows a mixed effect of PRHCP. This study evaluated the effect of PRHCP on physicians' prescribing practices in a sample of primary care institutions in China. Segmented regression analysis was used to produce convincing evidence for health policy and reform. METHODS The PRHCP intervention was implemented in Qian City that started on 1 October 2013. Performance data on prescription statistics were disclosed to patients and health workers monthly in 10 primary care institutions. A total of 326 655 valid outpatient prescriptions were collected. Monthly effective prescriptions were calculated as analytical units in the research (1st to 31st every month). This study involved multiple assessments of outcomes 13 months before and 11 months after PRHCP intervention (a total of 24 data points). RESULTS Segmented regression models showed downward trends from baseline on antibiotics (coefficient = -0.64, P = 0.004), combined use of antibiotics (coefficient = -0.41, P < 0.001) and injections (coefficient = -0.5957, P = 0.001) after PRHCP intervention. The average expenditure of patients slightly increased monthly before the intervention (coefficient = 0.8643, P < 0.001); PRHCP intervention also led to a temporary increase in average expenditure of patients (coefficient = 2.20, P = 0.307) but slowed down the ascending trend (coefficient = -0.45, P = 0.033). The prescription rate of antibiotics and injections after intervention (about 50%) remained high. CONCLUSIONS PRHCP showed positive effects on physicians' prescribing behaviour, considering the downward trends on the use of antibiotics and injections and average expenditure through the intervention. However, the effect was not immediately observed; a lag time existed before public reporting intervention worked.
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Affiliation(s)
- Chenxi Liu
- Tongji Medical College, School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Xinping Zhang
- Tongji Medical College, School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Wan
- Tongji Medical College, School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
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Elliott MN, Cohea CW, Lehrman WG, Goldstein EH, Cleary PD, Giordano LA, Beckett MK, Zaslavsky AM. Accelerating Improvement and Narrowing Gaps: Trends in Patients' Experiences with Hospital Care Reflected in HCAHPS Public Reporting. Health Serv Res 2015; 50:1850-67. [PMID: 25854292 DOI: 10.1111/1475-6773.12305] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Measure HCAHPS improvement in hospitals participating in the second and fifth years of HCAHPS public reporting; determine whether change is greater for some hospital types. DATA Surveys from 4,822,960 adult inpatients discharged July 2007-June 2008 or July 2010-June 2011 from 3,541 U.S. hospitals. STUDY DESIGN Linear mixed-effect regression models with fixed effects for time, patient mix, and hospital characteristics (bedsize, ownership, Census division, teaching status, Critical Access status); random effects for hospitals and hospital-time interactions; fixed-effect interactions of hospital characteristics and patient characteristics (gender, health, education) with time predicted HCAHPS measures correcting for regression-to-the-mean biases. DATA COLLECTION METHODS National probability sample of adult inpatients in any of four approved survey modes. PRINCIPAL FINDINGS HCAHPS scores increased by 2.8 percentage points from 2008 to 2011 in the most positive response category. Among the middle 95 percent of hospitals, changes ranged from a 5.1 percent decrease to a 10.2 percent gain overall. The greatest improvement was in for-profit and larger (200 or more beds) hospitals. CONCLUSIONS Five years after HCAHPS public reporting began, meaningful improvement of patients' hospital care experiences continues, especially among initially low-scoring hospitals, reducing some gaps among hospitals.
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Affiliation(s)
| | - Christopher W Cohea
- Surveys, Research & Analysis Division, Health Services Advisory Group, Phoenix, AZ
| | - William G Lehrman
- Center for Beneficiary Choices Department, Centers for Medicare and Medicaid Services, Baltimore, MD
| | - Elizabeth H Goldstein
- Center for Beneficiary Choices Department, Centers for Medicare and Medicaid Services, Baltimore, MD
| | - Paul D Cleary
- School of Public Health, Yale University, New Haven, CT
| | - Laura A Giordano
- Surveys, Research & Analysis Division, Health Services Advisory Group, Phoenix, AZ
| | | | - Alan M Zaslavsky
- Harvard Medical School, Department of Health Care Policy, Boston, MA
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Gutacker N, Street A, Gomes M, Bojke C. Should English healthcare providers be penalised for failing to collect patient-reported outcome measures? A retrospective analysis. J R Soc Med 2015; 108:304-16. [PMID: 25827906 DOI: 10.1177/0141076815576700] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The best practice tariff for hip and knee replacement in the English National Health Service (NHS) rewards providers based on improvements in patient-reported outcome measures (PROMs) collected before and after surgery. Providers only receive a bonus if at least 50% of their patients complete the preoperative questionnaire. We determined how many providers failed to meet this threshold prior to the policy introduction and assessed longitudinal stability of participation rates. DESIGN Retrospective observational study using data from Hospital Episode Statistics and the national PROM programme from April 2009 to March 2012. We calculated participation rates based on either (a) all PROM records or (b) only those that could be linked to inpatient records; constructed confidence intervals around rates to account for sampling variation; applied precision weighting to allow for volume; and applied risk adjustment. SETTING NHS hospitals and private providers in England. PARTICIPANTS NHS patients undergoing elective unilateral hip and knee replacement surgery. MAIN OUTCOME MEASURES Number of providers with participation rates statistically significantly below 50%. RESULTS Crude rates identified many providers that failed to achieve the 50% threshold but there were substantially fewer after adjusting for uncertainty and precision. While important, risk adjustment required restricting the analysis to linked data. Year-on-year correlation between provider participation rates was moderate. CONCLUSIONS Participation rates have improved over time and only a small number of providers now fall below the threshold, but administering preoperative questionnaires remains problematic in some providers. We recommend that participation rates are based on linked data and take into account sampling variation.
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Affiliation(s)
- Nils Gutacker
- Centre for Health Economics, University of York, York YO10 5DD, UK
| | - Andrew Street
- Centre for Health Economics, University of York, York YO10 5DD, UK
| | - Manuel Gomes
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Bojke
- Centre for Health Economics, University of York, York YO10 5DD, UK
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Abstract
This Special Section of Health Economics, Policy and Law begins with an article on the different ways in which one might incentivise improved performance among health care providers. I asked five experts on performance management, Gwyn Bevan, Tim Doran, Peter Smith, Sandra Tanenbaum and Karsten Vrangbaek, to write brief reactions to the article and to the notion of performance management in health care in general. The commentators were given an open remit to be as critical as they wished to be, and their reactions can be found in the pages that follow. I would like to thank Albert Weale for reviewing all of the articles, and Katie Brennan for serving as the catalyst for this collection.
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Beukers PDC, Kemp RGM, Varkevisser M. Patient hospital choice for hip replacement: empirical evidence from the Netherlands. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2014; 15:927-36. [PMID: 24158316 DOI: 10.1007/s10198-013-0535-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 09/23/2013] [Indexed: 05/16/2023]
Abstract
In the Dutch health care system, hospitals are expected to compete. A necessary condition for competition among hospitals is that patients do not automatically choose the nearest hospital, but are-at least to some extent-sensitive to differences in hospital quality. In this study, an analysis is performed on the underlying features of patient hospital choice in a setting where prices do not matter for patients as a result of health insurance coverage. Using claims data from all Dutch hospitals over the years 2008-2010, a conditional logit model examines the relationship between patient characteristics (age, gender and reoperations) and hospital attributes (hospital quality information, waiting times on treatments and travel time for patients to the hospitals) in the market for general non-emergency hip replacement treatments. The results show that travel time is the most important determinant in patient hospital choice. From our analysis, however, it follows that publicly available hospital quality ratings and waiting times also have a significant impact on patient hospital choice. The panel data used for this study (2008-2010) is rather short, which may explain why no coherent and persistent changes in patient hospital choice behaviour over time are found.
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Affiliation(s)
- Puck D C Beukers
- Performation Healthcare Intelligence B.V., Bilthoven, The Netherlands
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Zhang X, Wang L, Zhang X. Application of propensity scores to explore the effect of public reporting of medicine use information on rational drug use in China: a quasi-experimental design. BMC Health Serv Res 2014; 14:492. [PMID: 25384897 PMCID: PMC4232652 DOI: 10.1186/s12913-014-0492-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/06/2014] [Indexed: 12/02/2022] Open
Abstract
Background Transparency has become a hottest topic and a growing movement in the health care system worldwide. This study used a quasi-experimental design method to explore whether public reporting of medicine use information can improve rational drug use. Methods 20 township hospitals and 274 doctors of City Y in Hubei Province, China were divided into the intervention and control groups on the basis of their characteristics. In the intervention group, the values and rankings of the average expenditure per prescription, percentage of prescriptions requiring antibiotics and percentage of prescriptions requiring injections of each hospital and doctor were publicly released to patients and doctors in an appropriate format monthly. Data were gathered both four months before and after the intervention. Propensity score matching (PSM) was used to minimize the observed covariate (gender, age, experience, education level, title, and monthly income) differences in the doctors’ characteristics. 108 pairs of doctors were obtained after PSM. Chi-square test and t-test were employed to explore the effect of public reporting of medicine use information on rational drug use. The study was approved by the Committee of Tongji Medical College, Hua Zhong University of Science and Technology (IORG No: IORG0003571). Results In baseline, the average expenditure per prescription of the 274 doctors was 42.82 RMB yuan (USD 6.97), the percentage of prescriptions requiring antibiotics was 63.00%, and the percentage of prescriptions requiring injections was 70.79%, all higher than the average of Hubei Province and the standard recommended by WHO. Before the intervention all the three indicators were all comparable (p > 0.05), whereas after the intervention, a significant difference (p < 0.05) was found for the percentage of prescriptions requiring injections between the intervention (64.66%) and control groups (70.52%). Conclusions Irrational drug use remains a policy issue in township hospitals in the study area. We demonstrated that publicly reporting medicine use information could decrease the percentage of prescriptions requiring injections in township hospitals in China, but this effect was not observed on prescription costs and antibiotics use. Analyses of the mechanism and long-term effect of public reporting of medicine use information are recommended for further studies.
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Wang X, Tang Y, Zhang X, Yin X, Du X, Zhang X. Effect of publicly reporting performance data of medicine use on injection use: a quasi-experimental study. PLoS One 2014; 9:e109594. [PMID: 25313853 PMCID: PMC4196947 DOI: 10.1371/journal.pone.0109594] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/08/2014] [Indexed: 12/21/2022] Open
Abstract
Background Inappropriate use of prescribing pharmaceuticals, particularly injections, not only affects the quality of medical care, but also leads to an increase in medical expenses. Publicly reporting performance data of medical care is becoming a common health policy tool adopted to supervise medical quality. To our knowledge, few studies about public reporting applied to medicine use have been reported. This study intended to introduce public reporting in the field of medicine use, and evaluate the effect of publicly reporting performance data of medicine use on the use of injections. Methods The research sites were 20 primary healthcare institutions in Q City, Hubei. By matching, the institutions were divided into the intervention group and control group. A quasi-experimental design was applied in this study. In the intervention group, the performance data of medicine use were publicly reported. The injection prescribing rates of the two groups before and after intervention were measured and compared. Difference-in-difference method and logistic regression were employed to estimate the effect of public reporting on injection use. Results Public reporting led to a reduction of approximately 4% in the injection prescribing rate four months after intervention (OR = 0.96; 95%CI: 0.94, 0.97). The intervention effect was inconsistent in each month after intervention, and it was most positive in the second month after intervention (OR = 0.90; 95%CI: 0.89, 0.92). Conclusions In general, publicly reporting performance data of medicine use may have positive effects on injection use to some extent. Further research is needed to investigate the mechanism by which public reporting influences injection use. Comprehensive measures are also necessary to promote the rational use of injections.
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Affiliation(s)
- Xuan Wang
- School of Medicine and Health Management, Tongji Medical College, HuaZhong University of Science and Technology, Wuhan, HuBei Province, China
| | - Yuqing Tang
- School of Medicine and Health Management, Tongji Medical College, HuaZhong University of Science and Technology, Wuhan, HuBei Province, China
| | - Xiaopeng Zhang
- School of Medicine and Health Management, Tongji Medical College, HuaZhong University of Science and Technology, Wuhan, HuBei Province, China
| | - Xi Yin
- School of Medicine and Health Management, Tongji Medical College, HuaZhong University of Science and Technology, Wuhan, HuBei Province, China
| | - Xin Du
- School of Medicine and Health Management, Tongji Medical College, HuaZhong University of Science and Technology, Wuhan, HuBei Province, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, HuaZhong University of Science and Technology, Wuhan, HuBei Province, China
- * E-mail:
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Ahmed F, Burt J, Roland M. Measuring patient experience: concepts and methods. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 7:235-41. [PMID: 24831941 DOI: 10.1007/s40271-014-0060-5] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Providing a good patient experience is a key part of providing high-quality medical care. This paper explains why patient experience is important in its own right, and its relationship to other domains of quality. We describe methods of measuring patient experience, including issues relating to validity, reliability and response bias. Differences in reported patient experience may sometimes reflect differences in expectations of different population groups and we describe the arguments for and against adjusting patient experience data for population characteristics. As with other quality improvement strategies, feeding back patient experience data on its own is unlikely to improve quality: sustained and multiple interventions are usually required to deliver sustained improvements in care.
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Affiliation(s)
- Faraz Ahmed
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge, CB2 0SR, UK,
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Yang L, Liu C, Wang L, Yin X, Zhang X. Public reporting improves antibiotic prescribing for upper respiratory tract infections in primary care: a matched-pair cluster-randomized trial in China. Health Res Policy Syst 2014; 12:61. [PMID: 25304996 PMCID: PMC4197333 DOI: 10.1186/1478-4505-12-61] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 09/25/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inappropriate use and overuse of antibiotics is a serious concern in the treatment of upper respiratory tract infections (URTIs), especially in developing countries. In recent decades, information disclosure and public reporting (PR) has become an instrument for encouraging good practice in healthcare. This study evaluated the impact of PR on antibiotic prescribing for URTIs in a sample of primary care institutions in China. METHODS A matched-pair cluster-randomized trial was undertaken in QJ city, with 20 primary care institutions participating in the trial. Participating institutions were matched into pairs before being randomly assigned into a control and an intervention group. Prescription statistics were disclosed to patients, health authorities, and health workers monthly within the intervention group, starting from October 2013. Outpatient prescriptions for URTIs were collected from both groups before (1st March to 31st May, 2013) and after the intervention (1st March to 31st May, 2014). A total of 34,815 URTI prescriptions were included in a difference-in-difference analysis using multivariate linear or logistic regression models, controlling for patient attributes as well as institutional characteristics. RESULTS Overall, 90% URTI prescriptions required antibiotics and 21% required combined use of antibiotics. More than 77% of URTI prescriptions required intravenous (IV) injection or infusion of drugs. PR resulted in a 9 percentage point (95% CI -17 to -1) reduction in the use of oral antibiotics (adjusted RR = 39%, P = 0.027), while the use of injectable antibiotics remained unchanged. PR led to a 7 percentage point reduction (95% CI -14 to 0; adjusted RR = 36%) in combined use of antibiotics (P = 0.049), which was largely driven by a significant reduction in male patients (-7.5%, 95% CI -14 to -1, P = 0.03). The intervention had little impact on the use of IV injections or infusions, or the total prescription expenditure. CONCLUSIONS The results suggest that PR could improve prescribing practices in terms of reducing oral antibiotics and combined use of antibiotics; however, the impacts were limited. We suggest that PR would probably be enhanced by provider payment reform, management and training for providers, and health education for patients.
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Affiliation(s)
- Lianping Yang
- />School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, No.13. Hangkong Road, Wuhan, Hubei province 430030 PR China
| | - Chaojie Liu
- />School of Public Health, La Trobe University, 1 Kingsbury Dr, Bundoora, Victoria, 3086 Australia
| | - Lijun Wang
- />School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, No.13. Hangkong Road, Wuhan, Hubei province 430030 PR China
| | - Xi Yin
- />School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, No.13. Hangkong Road, Wuhan, Hubei province 430030 PR China
| | - Xinping Zhang
- />School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, No.13. Hangkong Road, Wuhan, Hubei province 430030 PR China
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Shaller D, Kanouse DE, Schlesinger M. Context-based strategies for engaging consumers with public reports about health care providers. Med Care Res Rev 2014; 71:17S-37S. [PMID: 23819945 PMCID: PMC5494710 DOI: 10.1177/1077558713493118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Efforts to engage consumers in the use of public reports on health care provider performance have met with limited success. Fostering greater engagement will require new approaches that provide consumers with relevant content at the time and in the context they need to make a decision of consequence. To this end, we identify three key factors influencing consumer engagement and show how they manifest in different ways and combinations for four particular choice contexts that appear to offer realistic opportunities for engagement. We analyze how these engagement factors play out differently in each choice context and suggest specific strategies that sponsors of public reports can use in each context. Cross-cutting lessons for report sponsors and policy makers include new media strategies such as a commitment to adaptive web-based reporting, new metrics with richer emotional content, and the use of navigators or advocates to assist consumers with interpreting reports.
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Golden AG, Silverman MA, Heller A, Loyal M, Cendan J. Potential Conflicting Interests for Surgeons in End-of-Life Care. Am J Hosp Palliat Care 2014; 32:763-6. [PMID: 25070078 DOI: 10.1177/1049909114543321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Thirty-day mortality represents a variable that is commonly used to measure the quality of surgical care. The definition of 30-day mortality and the application of a risk adjustment to its measurement may vary among different organizations comparing physician quality. In the midst of this confusion, conflicting interests arise for surgeons who must weigh the potential benefit of surgical interventions to individual patients versus the potential loss of access by future patients should 30-day mortality ratings be adversely affected. Similarly, surgeons may become adversely impacted by the lack of compensation from avoiding "high-risk" cases, but might face a more severe financial impact if they have a higher mortality rating compared to their peers.
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Affiliation(s)
- Adam G Golden
- Orlando Veterans Affairs Medical Center, Orlando, FL, USA University of Central Florida College of Medicine, Orlando, FL, USA
| | | | - Andrew Heller
- Orlando Veterans Affairs Medical Center, Orlando, FL, USA
| | | | - Juan Cendan
- University of Central Florida College of Medicine, Orlando, FL, USA
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Emmert M, Hessemer S, Meszmer N, Sander U. Do German hospital report cards have the potential to improve the quality of care? Health Policy 2014; 118:386-95. [PMID: 25074783 DOI: 10.1016/j.healthpol.2014.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 06/12/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hospitals report cards have been put in place within the past few years to increase the amount of publicly reported quality information in Germany. OBJECTIVE The aim of this study was to assess the potential of German hospital report cards to improve quality of care. METHODS First, a systematic Internet search aimed at identifying available report cards was conducted. Second, cross-sectional data (August/September 2013) were analyzed with respect to awareness, comprehension, and impact of report cards by using descriptive analysis and binary multivariate logistic regression models. RESULTS Hospital report cards (N=62) have become broadly available. However, awareness remains low, about one third (35.6%) of all respondents (N=2027) were aware of German hospital report card. Regarding comprehensibility, in 60.7% of all experiments (N=6081), respondents selected the hospital with the lowest risk-adjusted mortality; significant differences could be determined between the report cards (p<.001) with scores ranging from 27.5% to 77.2%. Binary multivariate logistic regression analysis revealed different significant respondent-related predictors on each report card. Finally, an impact on hospital choice making was determined. CONCLUSIONS To increase the potential of hospital report cards, health policy makers should promote the availability of report cards. In addition, the comprehensibility of German hospital report cards cannot be regarded as satisfying and should be enhanced in the future.
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Affiliation(s)
- Martin Emmert
- Institute of Management (IFM), Friedrich-Alexander-University Erlangen-Nuremberg, Germany.
| | - Stefanie Hessemer
- Institute of Management (IFM), Friedrich-Alexander-University Erlangen-Nuremberg, Germany
| | - Nina Meszmer
- Institute of Management (IFM), Friedrich-Alexander-University Erlangen-Nuremberg, Germany
| | - Uwe Sander
- University of Applied Sciences and Arts, Hannover, Germany
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Nakamura F, Higashi T, Saruki N, Fukuhara S, Sobue T. Understanding by the general public of newspaper reports on publicly reported cancer survival in Japan: a randomized controlled trial. Jpn J Clin Oncol 2014; 44:651-60. [PMID: 24821974 DOI: 10.1093/jjco/hyu058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study was aimed to examine how well readers of newspapers understand cancer survival rate data, and the effect of this understanding on their behavioral intent. METHODS We recruited 1950 persons who were 20 years old or older registered with a market research company. Participants were randomly divided into 10 groups; 9 were assigned one of nine newspaper articles, and the remaining group was assigned the excerpt of the official Association of Clinical Cancer Centers web pages. The primary outcome was the proportion of respondents with 'sufficient understanding', who gave 70% or more correct answers on a 10-item knowledge question. RESULTS The proportion of participants with sufficient understanding varied across the groups (range: 0.8-22.1%, overall, P<0.001). Only around 15% of participants answered that they would consider other hospitals in a scenario where the only hospital in the participants' area had a 5-year survival of 5% or less, and answers did not significantly vary between groups (range: 11.1-21.0%, overall P=0.77). CONCLUSIONS The level of understanding of cancer survival rate varied by variation in media reporting. However, the effect of behavioral intent on hospital choice did not differ between articles. TRIAL REGISTRATION UMIN CTR UMIN000004885.
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Affiliation(s)
- Fumiaki Nakamura
- Department of Public Health/Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Takahiro Higashi
- Division of Cancer Health Services Research, Center for Cancer Control and Information Services, The National Cancer Center, Tokyo
| | - Nobuhiro Saruki
- Department of Anesthesia, Gunma Prefectural Cancer Center, Gunma
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine, Kyoto
| | - Tomotaka Sobue
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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Shiyanbola OO, Mort JR. Exploring consumer understanding and preferences for pharmacy quality information. Pharm Pract (Granada) 2014; 12:468. [PMID: 25580169 PMCID: PMC4282764 DOI: 10.4321/s1886-36552014000400004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/06/2014] [Indexed: 12/04/2022] Open
Abstract
Objective: To describe consumer understanding of pharmacy quality measures and consumer preferences for pharmacy quality information. Methods: Semi-structured focus group design was combined with survey methods. Adults who filled prescription medications for self-reported chronic illnesses at community pharmacies discussed their understanding of Pharmacy Quality Alliance approved quality measures. Questions examined preference of pharmacy quality information rating systems (e.g. stars versus percentages) and desired data display/formats. During the focus group, participants completed a survey examining their understanding of each pharmacy quality measure. All focus group discussions were transcribed verbatim. Data were analyzed using thematic analysis and descriptive statistics. Results: Thirty-four individuals participated (mean age= 62.85; SD=16.05). Participants were unfamiliar with quality measures information and their level of understanding differed for each quality measure. Surveys indicated 94.1% understood “Drug-Drug Interactions” and “Helping Patients Get Needed Medications” better than other measures (e.g., 76.5% understood “Suboptimal Treatment of Hypertension in Patients with Diabetes”). Qualitative analysis indicated participants preferred an overall pharmacy rating for quick access and use. However, participants also wanted quality measures information displayed by health conditions. Participants favored comparison of their pharmacy to city data instead of state data. Most participants liked star ratings better than percentages, letter grades, or numerical ratings. Conclusions: Individuals who have a chronic illness and regularly use community pharmacies are interested in pharmacy quality measures. However, specific quality measures were not understood by some participants. Participants had specific preferences for the display of pharmacy quality information which will be helpful in the design of appropriate quality report systems.
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Affiliation(s)
- Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, University of Wisconsin-Madison . Madison, WI ( United States ).
| | - Jane R Mort
- Department of Pharmacy Practice, South Dakota State University . Brookings, SD ( United States ).
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