Public disclosure of performance data: learning from the US experience

The medical profession has, until recently, largely dictated standards of medical practice. If doctors completed their training and became licensed by the state they were trusted by the general public to provide clinical care with minimal obligation to show that they were achieving acceptable levels of performance. Several factors have caused this situation to change. A societal trend towards greater openness in public affairs has been fuelled by the ready availability of information in many areas of life outside of the health sector. A slow realisation of wide variation in practice standards1, 2 and occasional dramatic public evidence of deficiencies in quality of care3, 4 have led to demands by the public and government for greater openness from healthcare providers. The availability of computerised data and major advances in methods of measuring quality5 have allowed meaningful performance indicators to be developed for public scrutiny. The result has been advocacy for the use of standardised public reports on quality of care as a mechanism for improving quality and reducing costs.6–8 Publication of data about performance is not, however, new. In the 1860s Florence Nightingale highlighted the differences in mortality rates of patients in London hospitals,9 and in 1917 an American surgeon complained that fellow surgeons failed to publish their results because of fear that the public might not be impressed with the results.10 In most developed countries there is now an increasing expectation that healthcare providers should collect and report information on quality of care, that purchasers should use the information to make decisions on behalf of their population, and that the general public has a right to access that information. Organisations in the US have been publishing performance data, in the form of “report cards” or “provider profiles”, for over …

[1]  E. Hannan,et al.  Public release of cardiac surgery outcomes data in New York: what do New York state cardiologists think of it? , 1997, American heart journal.

[2]  J. Hibbard,et al.  Will quality report cards help consumers? , 1997, Health affairs.

[3]  B. Vladeċk,et al.  Consumers and hospital use: the HCFA "death list". , 1988, Health affairs.

[4]  H. Davies,et al.  Assessing the quality of care , 1995, BMJ.

[5]  J. Scott Armstrong,et al.  International journal of public administration: Lance Eliot Brouthers, parties, ideology and elections: The politics of federal revenues and expenditures forecasting, 8 (1986) 289-314 , 1988 .

[6]  Jonathan Mant,et al.  Detecting differences in quality of care: the sensitivity of measures of process and outcome in treating acute myocardial infarction , 1995, BMJ.

[7]  Russell L. Stogsdill,et al.  A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group. , 1996, JAMA.

[8]  J. Allison Risk adjustment for measuring health care outcomes , 1996 .

[9]  S. Engelmann,et al.  Can Medicare beneficiaries make informed choices? , 1998, Health affairs.

[10]  J. Jollis,et al.  Pennsylvania's Focus on Heart Attack--grading the scorecard. , 1998, The New England journal of medicine.

[11]  E J Topol,et al.  Outmigration for coronary bypass surgery in an era of public dissemination of clinical outcomes. , 1996, Circulation.

[12]  D B Nash,et al.  How Pennsylvania hospitals have responded to publicly released reports on coronary artery bypass graft surgery. , 1998, The Joint Commission journal on quality improvement.

[13]  J. M. Corrigan How do purchasers develop and use performance measures? , 1995, Medical care.

[14]  J. Gabel When Employers Choose Health Plans: Do NCQA Accreditation and HEDIS Data Count , 1998 .

[15]  R. Califf,et al.  Scorecard Cardiovascular Medicine: Its Impact and Future Directions , 1994, Annals of Internal Medicine.

[16]  N. Wintfeld,et al.  Report cards on cardiac surgeons. Assessing New York State's approach. , 1995, The New England journal of medicine.

[17]  E. DeLong,et al.  The effects of New York's bypass surgery provider profiling on access to care and patient outcomes in the elderly. , 1998, Journal of the American College of Cardiology.

[18]  M. Morrisey,et al.  Death and reputation: how consumers acted upon HCFA mortality information. , 1997, Inquiry : a journal of medical care organization, provision and financing.

[19]  E. McGlynn,et al.  The Appropriateness of Hysterectomy: A Comparison of Care in Seven Health Plans , 1993 .

[20]  H. Luft,et al.  The California Hospital Outcomes Project: using administrative data to compare hospital performance. , 1995, The Joint Commission journal on quality improvement.

[21]  R Smith,et al.  All changed, changed utterly , 1998, BMJ.

[22]  Duncan Neuhauser,et al.  Risk Adjustment for Measuring Health Care Outcomes , 1995 .

[23]  A. Epstein,et al.  Performance reports on quality--prototypes, problems, and prospects. , 1995, The New England journal of medicine.

[24]  E. McGlynn,et al.  Part 2: Measuring Quality of Care , 1996 .

[25]  C. Sirio,et al.  Public reporting of clinical outcomes--the data needs of health care stakeholders. , 1996, American journal of medical quality : the official journal of the American College of Medical Quality.

[26]  D. Berwick,et al.  Hospital leaders' opinions of the HCFA mortality data. , 1990, JAMA.

[27]  L I Iezzoni,et al.  The risks of risk adjustment. , 1997, JAMA.

[28]  R. Horton How should doctors respond to the GMC's judgments on Bristol? , 1998, Lancet.

[29]  D. Lansky Measuring what matters to the public. , 1998, Health affairs.

[30]  J. Hibbard,et al.  Comprehension of Quality Care Indicators: Differences Among Privately Insured, Publicly Insured, and Uninsured , 1996, Health care financing review.

[31]  P. Romano,et al.  The California Hospital Outcomes Project: how useful is California's report card for quality improvement? , 1998, The Joint Commission journal on quality improvement.

[32]  E. Hannan,et al.  The decline in coronary artery bypass graft surgery mortality in New York State. The role of surgeon volume. , 1995, JAMA.

[33]  Peter C Smith,et al.  On the unintended consequences of publishing performance data in the public sector , 1995 .

[34]  E L Hannan,et al.  Improving the outcomes of coronary artery bypass surgery in New York State. , 1994, JAMA.

[35]  E L Hannan,et al.  Benefits and hazards of reporting medical outcomes publicly. , 1996, The New England journal of medicine.

[36]  T. McBride,et al.  Volatility in Medicare AAPCC rates: 1990-1997. , 1997, Health affairs.

[37]  S. Robinson,et al.  Understanding the quality challenge for health consumers: the Kaiser/AHCPR Survey. , 1997, The Joint Commission journal on quality improvement.

[38]  Peter C. Smith,et al.  The NHS performance framework: taking account of economic behaviour , 1998 .

[39]  D. Lansky The new responsibility: measuring and reporting on quality. , 1993, The Joint Commission journal on quality improvement.

[40]  R. Berenson,et al.  A national survey of the arrangements managed-care plans make with physicians. , 1995, The New England journal of medicine.

[41]  R. Sturm,et al.  Costs and use of mental health services before and after managed care. , 1998, Health affairs.

[42]  A M Epstein,et al.  Rolling down the runway: the challenges ahead for quality report cards. , 1998, JAMA.

[43]  J. Hibbard,et al.  Choosing a health plan: do large employers use the data? , 1997, Health affairs.

[44]  R H Brook,et al.  Quality of health care. Part 2: measuring quality of care. , 1997, The New England journal of medicine.

[45]  D L Harper,et al.  Using hospital performance data in quality improvement: the Cleveland Health Quality Choice experience. , 1998, The Joint Commission journal on quality improvement.

[46]  R. Morton How should doctors respond to the CMC's judgments on Bristol? , 1998, The Lancet.

[47]  O'Leary Ds,et al.  Performance measures. How are they developed, validated, and used? , 1995 .

[48]  D. Longo,et al.  Consumer reports in health care. Do they make a difference in patient care? , 1997, JAMA.

[49]  F. Nightingale,et al.  Notes on Hospitals , 1860, The British and foreign medico-chirurgical review.

[50]  J P Kassirer,et al.  The use and abuse of practice profiles. , 1994, The New England journal of medicine.

[51]  L. Iezzoni Risk Adjustment for Measuring Healthcare Outcomes , 1994 .

[52]  R. Brook,et al.  Audit of coronary angiography and bypass surgery , 1990, The Lancet.

[53]  Peter Orton,et al.  The New NHS: Modern and Dependable? , 1998 .

[54]  A M Epstein,et al.  Use of public performance reports: a survey of patients undergoing cardiac surgery. , 1998, JAMA.

[55]  Harvey Goldstein,et al.  League Tables and Their Limitations: Statistical Issues in Comparisons of Institutional Performance , 1996 .

[56]  A M Epstein,et al.  Influence of cardiac-surgery performance reports on referral practices and access to care. A survey of cardiovascular specialists. , 1996, The New England journal of medicine.

[57]  Andrew D Oxman,et al.  Closing the gap between research and practice : an overview of systematic reviews of interventions to promote the implementation of research findings , 2011 .

[58]  P. Cleary,et al.  What information do consumers want and need? , 1996, Health affairs.

[59]  J O Sundin,et al.  Assessing quality of care. , 2000, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.