Do consumers respond to publicly reported quality information? Evidence from nursing homes

Public reporting of quality information is designed to address information asymmetry in health care markets. Without public reporting, consumers may have little information to help them differentiate quality among providers, giving providers little incentive to compete on quality. Public reporting enables consumers to choose highly ranked providers. Using a four-year (2000-2003) panel dataset, we examine the relationship between report card scores and patient choice of nursing home after the Centers for Medicare and Medicaid Services began publicly reporting nursing home quality information on post-acute care in 2002. We find that the relationship between reported quality and nursing home choice is positive and statistically significant suggesting that patients were more likely to choose facilities with higher reported post-acute care quality after public reporting was initiated. However, the magnitude of the effect was small. We conclude that there has been minimal consumer response to information in the post-acute care market.     

Making the grade: update on report card initiatives for 1997

Report cards for healthcare services are increasingly in the news, offering the hope that objective information on the quality of health plan and providers services will eventually enable purchasers and consumers to make selections based on true value. Following is a series of five brief articles that review ongoing report card initiatives in private and public sectors of the behavioral healthcare system. The first four articles review actual report cards designed to hold organizations--particularly managed care--accountable for the quality of their services. The last article reviews research on performance measurement across all segments of the behavioral healthcare industry.     

Publicly disclosed information about the quality of health care: response of the US public

Public disclosure of information about the quality of health plans, hospitals, and doctors continues to be controversial. The US experience of the past decade suggests that sophisticated quality measures and reporting systems that disclose information on quality have improved the process and outcomes of care in limited ways in some settings, but these efforts have not led to the "consumer choice" market envisaged. Important reasons for this failure include limited salience of objective measures to consumers, the complexity of the task of interpretation, and insufficient use of quality results by organised purchasers and insurers to inform contracting and pricing decisions. Nevertheless, public disclosure may motivate quality managers and providers to undertake changes that improve the delivery of care. Efforts to measure and report information about quality should remain public, but may be most effective if they are targeted to the needs of institutional and individual providers of care.     

Developing an outcomes report card for hospitals: a case study and implementation guidelines

Except for a few state mandates and dominant business coalitions in selected markets, the provider report card initiative is a voluntary response to a perceived public desire for performance data on healthcare providers. This study uses a detailed investigation of a single "typical" case to collect information about one hospital's decision processes and the operational activities required to develop a report card for communicating clinical outcomes and financial indicators to its external stakeholders. Three research questions are addressed: How did the organization identify who its key stakeholders for outcomes information were? How were the stakeholders' outcomes information needs determined? What were the stakeholders' information needs and preferred reporting formats? The research findings are reported as a case study. A general model for developing and implementing a report card for public dissemination is proposed. Crucial steps include: Hospital leaders should define the intent of the report card and identify key performance domains. Stakeholders' needs, desires, and intended use of the information should be explored when determining the format of the report card. External validation of the information presented should be obtained. The report should be made available through several mediums including direct mailing, print media, and the Internet. Usefulness of the information included in the report card should be continually evaluated. The outcomes report card can be useful to organizations and their stakeholders in many ways. They provide information about clinical outcomes, cost-effectiveness, and organizational performance in an era when healthcare organizations are competing for marketshare and consumers are demanding to be informed about their healthcare providers.     

Making the grade: a status report on hospital report cards

Hospital report cards that document patients' medical outcomes are attracting increasing attention for their role in guiding health care decisions by employers, consumers and providers. Significant questions remain, however, regarding the validity and utility of this information. This Issue Brief is based on a seminar held by the Center for Studying Health System Change at which two expert panels discussed whether report cards make the grade. The first panel approached this subject through a Socratic dialogue that focused on the release of a hypothetical community hospital report card. The second panel weighed in on two research presentations related to report cards. The panelists agreed that efforts to collect and report clinical outcomes data are flawed. Even so, release of the data can help improve clinical quality and foster an environment in which health care quality information ultimately has an impact on health care decision making.     

Health care consumer reports: an evaluation of consumer perspectives

There has been a proliferation of health care consumer reports, also known as "consumer guides," "report cards," and "performance reports," which are designed to assist consumers in making more informed health care decisions. While there is evidence that providers use such reports to identify and make changes in practice, thus improving the quality of care, there is little empirical evidence on how consumer guides/report cards are used by consumers. This study fills that gap by surveying 925 patients as they wait for ambulatory care in several clinics in a midwestern city. Findings indicate that consumers are selective in their use of these reports and quickly identify those sections of the report of most interest to them. Report developers should take precautions to ensure such reports are viewed as credible sources of health care information.     

Public reporting on quality in the United States and the United Kingdom

The public reporting of comparative information about health care quality is becoming an accepted way of improving accountability and quality. Quality report cards have been prominent in the United States for more than a decade and are a central feature of British health system reform. In this paper we examine the common challenges and differences in implementation of the policy in the two countries. We use this information to explore some key questions relating to the content, target audience, and use of published information. We end by making specific recommendations for maximizing the effectiveness of public reporting.     

Do markets respond to quality information? The case of fertility clinics

Although policymakers have increasingly turned to provider report cards as a tool to improve health care quality, existing studies provide mixed evidence on whether they influence consumer choices. We examine the effects of providing consumers with quality information in the context of fertility clinics providing Assisted Reproductive Therapies (ART). We report three main findings. First, clinics with higher birth rates had larger market shares after the adoption of report cards relative to before. Second, clinics with a disproportionate share of young, relatively easy-to-treat patients had lower market shares after adoption versus before. This suggests that consumers take into account information on patient mix when evaluating clinic outcomes. Third, report cards had larger effects on consumers and clinics from states with ART insurance coverage mandates. We conclude that consumers respond to quality report cards when choosing among providers of ART.     

Health care report cards: what about consumers' perspectives?

Though the report card style is seen by many as a way to create better-informed consumers, very little is actually known about how consumers will respond to health care report cards. Report cards are only one of many factors that influence health care decision making. Much consumer-oriented effort and fine-tuning will be required to make report cards effective. Using the approach called "social marketing" as a framework, specific examples are used to outline some ideas for more intensive pursuit of consumers' perspectives in the design and distribution of report cards.     

Public reporting of hospital quality shows inconsistent ranking results

Background

Evidence from the US has demonstrated that hospital report cards might generate confusion for consumers who are searching for a hospital. So far, little is known regarding hospital ranking agreement on German report cards as well as underlying factors creating disagreement.

Consumers' and providers' responses to public cost reports, and how to raise the likelihood of achieving desired results

There is tremendous interest in different approaches to slowing the rise in US per capita health spending. One approach is to publicly report on a provider's costs--also called efficiency, resource use, or value measures--with the hope that consumers will select lower-cost providers and providers will be encouraged to decrease spending. In this paper we explain why we believe that many current cost-profiling efforts are unlikely to have this intended effect. One of the reasons is that many consumers believe that more care is better and that higher-cost providers are higher-quality providers, so giving them information that some providers are lower cost may have the perverse effect of deterring them from accessing these providers. We suggest changes that can be made to content and design of public cost reports to increase the intended consumer and provider response.     

Improving the quality of long-term care with better information

Publicly reporting information stimulates providers' efforts to improve the quality of health care. The availability of mandated, uniform clinical data in all nursing homes and home health agencies has facilitated the public reporting of comparative quality data. This article reviews the conceptual and technical challenges of applying information about the quality of long-term care providers and the evidence for the impact of information-based quality improvement. Quality "tools" have been used despite questions about the validity of the measures and their use in selecting providers or offering them bonus payments. Although the industry now realizes the importance of quality, research still is needed on how consumers use this information to select providers and monitor their performance and whether these efforts actually improve the outcomes of care.     

Do employees use report cards to assess health care provider systems?

OBJECTIVE: To investigate consumers' use of report cards that provide information on service quality and satisfaction at the provider group level. DATA SOURCES: In 1998 we conducted a telephone survey of randomly selected employees in firms aligned with the Buyers Health Care Action Group (BHCAG) in the Minneapolis-St. Paul market. STUDY DESIGN: Univariate probit models were used to determine report card utilization, perceived helpfulness of the report card, and ease of selecting a provider group. The characteristics used in the models included health status, age, gender, education, residency, job tenure, marital status, presence of dependent children, household income, and whether consumers changed provider groups. DATA COLLECTION: Our sample consists of survey responses from 996 single individuals (a response rate of 91 percent) and 913 families (a response rate of 96 percent). The survey was supplemented with data obtained directly from employers aligned with BHCAG. PRINCIPLE FINDINGS: Consumers who changed to a new provider group are more likely to use report card information and find it helpful, consumers employed in large firms are less likely to use the report card, and families who use information from their own health care experiences are less likely to find the report card helpful. In addition, individuals who changed to a new provider group are more likely to find the selection decision difficult. CONCLUSION: The findings show that health care consumers are using satisfaction and service-quality information provided by their employers.     

Performance reporting of health care delivery systems: will it make the grade?

Recently, federal governments, state governments, and private sector groups have begun initiatives that would report the performance of health plans in key areas. United HealthCare Corporation's experience in developing and publicly releasing "report cards" for 15 of its health plans may prove useful as other efforts go forward. There are both advantages and challenges to producing a report card in terms of resource investment, directing health plans toward performance improvement, and the ability for both purchasers and policy makers to understand and make use of results. These and other issues will be important to consider as other segments of the health care industry, particularly providers, focus on reporting performance measures.     

Community communications: hospital uses its own report card to tell public how it's providing quality care

Over the years, many types of healthcare report cards have emerged to give consumers comparative quality information right at their fingertips. One organization, though, Licking Memorial Health Systems of Newark, OH, has created a report card over the past 3 years to tell the community how it is doing--keeping in mind healthcare issues that affect every member of the community. Getting these data at the hospital level required a new approach at the departmental levels.     

Do healthcare report cards cause providers to select patients and raise quality of care?

We exploit a brief period of asymmetric information during the implementation of Pennsylvania's 'report card' scheme for coronary artery bypass graft surgery to test for improvements in quality of care and selection of patients by healthcare providers. During the first 3 years of the 1990 s, providers in Pennsylvania had an incentive to bias report cards by selecting patients strategically, with patients having no access to the report cards. This dichotomy enables us to separate providers' selection of patients from patients' selection of providers. Using data from the Nationwide Inpatient Sample, we estimate a nonlinear difference-in-differences model and derive asymptotic standard errors. The mortality rate for bypass patient decreases by only 0.05 percentage points because of the report cards, which we interpret as evidence that quality of bypass surgery did not improve (at least in the short-term) nor did patient selection by providers occur. Our timing, estimation, and asymptotics are readily applicable to many other report card schemes.     

The impact of public performance reporting on health plan selection and switching: A systematic review and meta-analysis

The dissemination of public performance reporting (PPR) cards aims to increase utilisation of information on quality of care by consumers when making health plan choices. However, evaluations of PPR cards show that they have little impact on consumer choices. The aim of this study is to undertake a systematic review and meta-analysis of the impact of PPR cards in promoting health plan selection and switching between health plans by consumers. We searched five online databases and eight previous reviews for studies reporting findings on PPR and health plans. We extracted data and conducted quality assessment, systematic critical synthesis and meta-analyses on the included studies. We identified eight relevant health plan articles related to selection (n?=?2), switching (n?=?4), selection/switching (n?=?2). Meta-analyses showed that PPR was associated with an improvement in health plan selection and a very small deterioration in switching health plans though these changes were not statistically significant. Differences were observed between employer-sponsored health insurance and Medicare/Medicaid insurance. Given the small number of studies included in the review, further research examining the impact of PPR on health plan selection and switching in a range of insurance markets is required.     

Employer-specific versus community-wide report cards: is there a difference?

This article describes preliminary results from a natural experiment that tested the impact of report cards on employees. As part of the 1995 enrollment process, some members of the State of Minnesota Employee Group Insurance Program received report cards on the plans offered to them, and others did not. Both groups of employees had a chance to review a second community-wide report card covering all Minnesota plans that had been distributed by an independent organization through local newspapers. Both groups were surveyed before and after they made their health plan selections. We compare the likelihood of seeing, the intensity of reading, and the perceived helpfulness of the first, employer-specific report card with the second, community-wide report card for consumers who make plan selections.     

2007年兖州市传染病疫情网络直报质量分析

[目的]了解兖州市2007年传染病疫情网络直报质量,发现问题,总结经验,为进一步提高我市传染病疫情网络直报质量提供科学依据。[方法]使用Excel对2007年充州市报告单位信息和全部传染病报告卡进行分析,对报告单位的类型、报告情况、病例的重复报告、报告审核及时性、完整性进行综合分析评价。[结果]2007年全市共建立报告单位24个,其中18个单位通过系统报告传染病报告卡2002张。全市传染病报告及时率为97．62％,审核及时率为98．63％。从诊断到审核的平均间隔为0．40d,无重卡,未填写工作单位的传染病报告卡占63．08％。[结论]2007年传染病疫情网络直报工作虽然取得了一定成绩,但在报告单位网络直报率、报告审核及时率、报告卡填写完整率等方面仍需进一步提高。