Putting the public back in public reporting of health care quality.

RECENT EFFORTS TO INCREASE TRANSPARENCY REgarding the quality of health care have been guided, in part, by the notion that this information will help patients make better choices about where to seek care. Despite substantial progress in measure development and dissemination, there is limited evidence that patients are putting such information to use, and only 6% of Americans are familiar with Hospital Compare, the quality reporting Web site maintained by the Centers for Medicare & Medicaid Services (CMS). There are several reasons for this: patients who are acutely ill rarely have the time to compare potential sources of care, clinical knowledge is required to make sense of most hospital process measures, the concept of a risk-standardized outcome is difficult to understand, and patients may not recognize the possibility that quality of care might vary. Additionally, patients may still prefer referrals from trusted family members or physicians over information obtained on the internet; practical matters, such as hospital location, often trump other considerations; and insurance co-payments may instill additional barriers to choice. Another reason for the slow uptake of Hospital Compare and similar quality reporting Web sites is the relatively limited opportunity they provide for patients to take part in the process. With the exception of reporting the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), which surveys between 300 and 1000 randomly selected patients per hospital per year, quality reporting Web sites usually do not offer patients the opportunity to provide subjective feedback about the health care they receive. However, experience from nonmedical industries indicates that consumers are often as interested in the subjective judgments of their peers as they are in more formal measures of quality. Web sites are emerging that allow patients to write reviews of their physicians and hospitals, and although only a limited number of patients appear to be posting information on such Web sites, it seems likely that powerful demographic and cultural forces may lead to increased use of these sites over time.