Comparative Hospital System Performance Web Sites – A Good Thing?

In the last few years there has been a push to let consumers know a great deal more about Hospital and health system performance. This interesting article appeared a few days ago.

Value of Health Care Cost, Quality Web Sites Might Be Overestimated

by Kate Ackerman, iHealthBeat Associate Editor

Three-fourths of health care opinion leaders responding to a November 2007 Commonwealth Fund/Modern Healthcare survey said that increased quality and price transparency is important or very important to improving the U.S. health care system.

In the last couple years, several states, payers and other health care organizations have responded to this demand for transparency by developing online health care cost and quality Web sites. The thinking is that by providing consumers with information to make informed health care decisions and by injecting competition into the health care market, costs will decrease and quality will increase.

However, consumers so far have been slow to use the information, and physicians often don't know how or if they should act on the data. Touting the sites as a mechanism to transform the health care system might be overestimating their value, some health experts say.

Continue reading this excellent article here:

http://www.ihealthbeat.org/articles/2008/2/8/Value-of-Health-Care-Cost-Quality-Web-Sites-Might-Be-Overestimated.aspx?a=1

Further web information can be found at the links below:

• Center for Studying Health System Change
• Colmers, "Public Reporting And Transparency," Commonwealth Fund, 1/07
• Commonwealth Fund/Modern Healthcare Opinion Leaders Survey

The issue has also been explored recently (as previously mentioned on the blog) in the following article:

http://www.annals.org/cgi/content/abstract/148/2/111

Systematic Review: The Evidence That Publishing Patient Care Performance Data Improves Quality of Care

Constance H. Fung, MD, MSHS; Yee-Wei Lim, MD, PhD; Soeren Mattke, MD, DSc; Cheryl Damberg, PhD; and Paul G. Shekelle, MD, PhD

15 January 2008 | Volume 148 Issue 2 | Pages 111-123

Background: Previous reviews have shown inconsistent effects of publicly reported performance data on quality of care, but many new studies have become available in the 7 years since the last systematic review.

Purpose: To synthesize the evidence for using publicly reported performance data to improve quality.

Data Sources: Web of Science, MEDLINE, EconLit, and Wilson Business Periodicals (1999–2006) and independent review of articles (1986–1999) identified in a previous systematic review. Only sources published in English were included.

Study Selection: Peer-reviewed articles assessing the effects of public release of performance data on selection of providers, quality improvement activity, clinical outcomes (effectiveness, patient safety, and patient-centeredness), and unintended consequences.

Data Extraction: Data on study participants, reporting system or level, study design, selection of providers, quality improvement activity, outcomes, and unintended consequences were extracted.

Data Synthesis: Forty-five articles published since 1986 (27 of which were published since 1999) evaluated the impact of public reporting on quality. Many focus on a select few reporting systems. Synthesis of data from 8 health plan–level studies suggests modest association between public reporting and plan selection. Synthesis of 11 studies, all hospital-level, suggests stimulation of quality improvement activity. Review of 9 hospital-level and 7 individual provider–level studies shows inconsistent association between public reporting and selection of hospitals and individual providers. Synthesis of 11 studies, primarily hospital-level, indicates inconsistent association between public reporting and improved effectiveness. Evidence on the impact of public reporting on patient safety and patient-centeredness is scant.

Limitations: Heterogeneity made comparisons across studies challenging. Only peer-reviewed, English-language articles were included.

Conclusion: Evidence is scant, particularly about individual providers and practices. Rigorous evaluation of many major public reporting systems is lacking. Evidence suggests that publicly releasing performance data stimulates quality improvement activity at the hospital level. The effect of public reporting on effectiveness, safety, and patient-centeredness remains uncertain.

These two articles explore the issue of just how useful complex information is to consumers. It seems to me that while lacking transparency is always a bad thing it is vital that the information that is released is both easily understandable and comparable so the consumer has something reliable to base decision making on.

As noted in a previous blog there are well thought out comparable clinical outcome performance indicators available and it is these that should be used – with appropriate explanations – to inform the public on hospital performance.

It is interesting to note that the major effect that has been detected following data release is an increase in internal quality improvement activity. If this activity is well directed this over time is surely a good thing indeed and makes such transparency a reasonable goal –with the caveat that the indicators being worked on a relevant and accurately reflect desired clinical and patient outcomes.

It seems to me this is still a work in progress.

David.